TOWN OF RICHMOND



TOWN OF RICHMOND

TIF BUSINESS LOAN PROGRAM APPLICATION

Amount Requested: $__________________ (Limit $25,000.)

Application Fee (Non-refundable) $100.00 (plus closing costs)

Proposed term of loan in years (up to 5 years) ____________________

If you need additional space to complete any section of this application, please attach additional sheets, making sure that you identify the section and item number to which the attachment applies.

| |Purpose of Loan: | |

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| |Describe how this loan will help your business: | |

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I. BUSINESS OWNERS NAMES

|Name(s) |SS# |Address |City |State |Zip |

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|1. |Length of Business in Richmond: | |Yrs. |U.S.|No | |

| | | | |Citi| | |

| | | | |zen:| | |

| | | | |Yes | | |

|2. | | | | | | |

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|3. |Business Phone: | |Fax: | |Home Phone: |

|5. |Business Name: | |

|6. |Business Location: |

| | |Must be physically located in Richmond, Maine | | | |

|7. |Business Address: |

|8. |Business Description: | |

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|9. | | |

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|10. | | |

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|11. | | |

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|12. | | |

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| |Do you own the building: | |

| |If so, Map: | |Lot: | | |

| |Book: | |Page: | | |

| |Business Establishment Date: | |Number of Employees: | |Full Time |

| | | |(Include Owners) | |Part Time |

| |Start Up/Projected Date: | |(If Applicable) |

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| |Federal Tax ID #: | |If Applicable | |

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|13. |Type of Business: |Partnership Sole Proprietorship Not Yet Established LLC |

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| | |S. Corporation C Corporation Other | |

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|14. |Is your business: |Profit Non-Profit | |

|15. |Do you have any personal judgments, business judgments, unsettled lawsuits, major disputes, bankruptcy or insolvency, tax liens against you or pending |

| |against you? Yes No |

| |If yes, please explain: | |

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|16. |Have you had any past credit problems that would affect your capacity to meet your current obligations as well as the projected payment of this loan: Yes|

| |No |

| |If yes, please explain: | |

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II. BUSINESS PLAN INFORMATION

|17. |Have you completed a Business Plan? Yes (If yes, please attach copy) |

| |No (If no, please identify when one will be developed?) |

| |Date Prepared: | |Prepared By: | |

| | Check here if you need assistance or information about Business Plan preparation. |

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III. LOAN PURPOSE AND FINANCIAL INFORMATION

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|18. |Identify the bank (s) or other conventional lender(s) from whom you may have sought a loan: |

| |(If possible attach letter(s) of commitment and/or denial) |

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|19. |Specify in more detail the description and use of funds for this project: |

|Supplies/Merchandise: | |$ | |

|Tools/Equipment: | |$ | |

|Construction: | |$ | |

|Renovation: | |$ | |

|Land/Real Estate: | |$ | |

|Marketing/Advertising: | |$ | |

|Debt consolidation: | |$ | |

|Retention/Creation Employment: | |$ | |

|Other: | |$ | |

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| |Total |$ | |

|20. |Value of collateral offered | | | |

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|21. | | | | |

| |$ | |Business assets, detail | | |

| |$ | |Home $ | |Mortgage remaining |

| |$ | |Co-Signer guarantee, source |

| |$ | |Other, specify | |

| | | | | | |

| |Other amounts and sources of household income | | | | |

| |$ | |Source | | |

| |$ | |Source | | |

| |$ | |Source | | |

|22. |Estimated Annual Business Income $ | | |

| |Estimated Monthly Business Income $ | | |

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|23. | | | |

| |Average Monthly Owner’s Draw $ | | |

| |Owner’s financial investment in the business in the past 6 months $ | | | |

| |For multiple owners, please furnish information on a separate sheet | | |

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| |Identify any currently available sources of business credit: | |

| |$ | |Personal savings | |

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|24. | | | | |

| |$ | |Credit Cards | |

| |$ | |Shadow partners or other, specify | |

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| |Estimated Net Worth of Business Real Estate, inventory/equipment | |

| |Business Real Estate $ | |- Mortgage $ | |= |

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|25. | | | | | |

| |Number of jobs created | |for each describe job title(s) |

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IV. BUSINESS EXPERIENCE

|26. |Is this your first business? Yes No |

| |How long have you owned this business? | |Years | |Months |

| |If No, what other businesses have you owned or been employed by in the previous five years: |

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27. Owner’s direct participation in this business is Full Time Part Time or Other

|If Other, describe estimated total weekly hours: | |

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|28. |Please provide a brief description of why you are in this business: | |

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|39. | | |

| |Please describe your three highest priority measures of success for this business: | |

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|30. | | |

| |Describe your two most effective competitors: | |

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|31. | | |

| |Compared with your competitors, what are your two most effective strengths and two biggest weaknesses. |

| |Strengths: | |

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| |Weaknesses: | |

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|32. |In the past six months, describe how your business has changed (consider number of customers, total sales, business income, kinds of services or products, |

| |marketing or promotions, leadership recognition, service to your community: |

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|33. | | |

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| |Describe the two most difficult challenges you have had to face in building your business and how you have dealt with them: |

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SCHEDULE 1. CREDIT REFERENCES

|Name(s) |Address/City/State/Zip |Phone Number |Account Number |

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SCHEDULE 2. BALANCE SHEET; WHAT YOU OWN: CURRENT VALUE

Cash on hand; Bank accounts, name of bank, checking and savings

| |$ | |

| |$ | |

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|Investments; retirement accounts, IRA’s, mutual/money market funds, stocks, bonds | | |

| |$ | |

| |$ | |

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|Residential real estate; describe | | |

| |$ | |

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|Other real estate; describe | | |

| |$ | |

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|Life insurance company policy #/cash value; (no cash value for term insurance) | | |

| |$ | |

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|Vehicles; make, model, and year | | |

| |$ | |

| |$ | |

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|Equipment; type and year | | |

| |$ | |

| |$ | |

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|Money owed to you; notes and mortgages | | |

| |$ | |

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|Other assets of value; describe | | |

| |$ | |

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|Other; describe | | |

| |$ | |

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|TOTAL |$ | |

SCHEDULE 3. WHAT YOU OWE

| |OWED

TO | |BALANCE OWED | |MONTHLY PAYMENT | |

COLLATERAL | |MORTGAGES

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| | | | | | | | | |VEHICLE LOANS

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| | | | | | | | | |PERSONAL LOANS

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| | | | | | | | | |CREDIT CARDS

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| | | | | | | | | |STUDENT LOANS

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| | | | | | | | | |CHILD SUPPORT

| | | | | | | | | |UNPAID TAXES

| | | | | | | | | |OTHER

| | | | | | | | | |TOTAL OWED

| | |$ | | | | | | |

SCHEDULE 4. NET WORTH:

SCHEDULE 2. WHAT YOU OWN VALUE TOTAL $_________________

MINUS SCHEDULE 3. WHAT YOU OWE VALUE TOTAL $_________________

NET WORTH $_________________

SCHEDULE 5. PROFIT AND LOSS STATEMENT

Report Period: | |12 Months

1 Year Previous | |

This Year | |Projected 1st Year | |Projected 2nd

Year | |Revenue (sales)

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| | | | | | | | | |Total Revenue

| | | | | | | | | |Cost of Sales

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| | | | | | | | | |Total Cost of sales

| | | | | | | | | |Gross Profit

| | | | | | | | | |Expenses:

| | | | | | | | | |Salaries/Payroll

| | | | | | | | | |Payroll Expenses

| | | | | | | | | |Outside services

| | | | | | | | | |Supplies

| | | | | | | | | |Repairs/Maintenance

| | | | | | | | | |Advertising

| | | | | | | | | |Travel

| | | | | | | | | |Accounting/Legal

| | | | | | | | | |Utilities/Phone

| | | | | | | | | |Taxes

| | | | | | | | | |Interest

| | | | | | | | | |Depreciation

| | | | | | | | | |Other, Specify

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Total Expenses | | | | | | | | | |

Net Profit | | | | | | | | | |

SCHEDULE 6. BUSINESS HISTORY FINANCIALS (Established Businesses Only)

| |2003 | |2004 | |2005 | |2006 | |2007 | |Gross Sales |$ | |$ | |$ | |$ | |$ | | |Cost of goods sold |$ | |$ | |$ | |$ | |$ | | |Operating expenses |$ | |$ | |$ | |$ | |$ | | |Loan Payments |$ | |$ | |$ | |$ | |$ | | |Net Business Income |$ | |$ | |$ | |$ | |$ | | |Owners Draw |$ | |$ | |$ | |$ | |$ | | |

SCHEDULE 7. SIX MONTH CASH FLOW

| |Month 1 | |Month 2 | |Month 3 | |Month 4 | |Month 5 | |Month 6 | |A. Beginning Cash |$ | |$ | |$ | |$ | |$ | |$ | | |B. Cash In (Cash Receipts) |$ | |$ | |$ | |$ | |$ | |$ | | |From Sales |$ | |$ | |$ | |$ | |$ | |$ | | |From Loans |$ | |$ | |$ | |$ | |$ | |$ | | |From other sources |$ | |$ | |$ | |$ | |$ | |$ | | |B. Total cash in |$ | |$ | |$ | |$ | |$ | |$ | | |C. Cash Expenses (on going) | | | | | | | | | | | | | | |$ | |$ | |$ | |$ | |$ | |$ | | | |$ | |$ | |$ | |$ | |$ | |$ | | | |$ | |$ | |$ | |$ | |$ | |$ | | | |$ | |$ | |$ | |$ | |$ | |$ | | | |$ | |$ | |$ | |$ | |$ | |$ | | | |$ | |$ | |$ | |$ | |$ | |$ | | |C. Total Cash Expenses |$ | |$ | |$ | |$ | |$ | |$ | | |D. One-time cash payments | | | | | | | | | | | | | | |$ | |$ | |$ | |$ | |$ | |$ | | | |$ | |$ | |$ | |$ | |$ | |$ | | | |$ | |$ | |$ | |$ | |$ | |$ | | |D. Total One-Time |$ | |$ | |$ | |$ | |$ | |$ | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |E. Total Expenses before | | | | | | | | | | | | | |Owner’s Draw (C + D) |$ | |$ | |$ | |$ | |$ | |$ | | |F. Owner’s Draw |$ | |$ | |$ | |$ | |$ | |$ | | |G. Total Cash Out (E + F) |$ | |$ | |$ | |$ | |$ | |$ | | |H. Net Cash ( B-G) |$ | |$ | |$ | |$ | |$ | |$ | | |I. Ending Cash (A +H) |$ | |$ | |$ | |$ | |$ | |$ | | |(Shaded Area is Carried Over)

SCHEDULE 8. PROJECT BUDGET-SUMMARY OF EXPENDITURES

Activity | |TIF Loan | |Private Funds | |Other Funds | |Total | | | | | | | | | | | |Working Capital |$ | |$ | |$ | |$ | | |Inventory |$ | |$ | |$ | |$ | | |Real Property Acquisition |$ | |$ | |$ | |$ | | |Relocation |$ | |$ | |$ | |$ | | |Clearance & Demolition |$ | |$ | |$ | |$ | | |Site Improvement |$ | |$ | |$ | |$ | | |Utility Improvement |$ | |$ | |$ | |$ | | |New Construction |$ | |$ | |$ | |$ | | |Rehabilitation |$ | |$ | |$ | |$ | | |Parking Improvement |$ | |$ | |$ | |$ | | |Capital Equipment |$ | |$ | |$ | |$ | | |Profession Fees |$ | |$ | |$ | |$ | | |Other, Specify |$ | |$ | |$ | |$ | | |

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$ | |

$ | |

$ | |

$ | | | |$ | |$ | |$ | |$ | | |TOTAL PROJECT |$ | |$ | |$ | |$ | | |

SCHEDULE 9. COLLATERAL INFORMATION

Item or Description | |Model or Serial # | |Cost | |Market Value | |Existing Lien | |Name of Lien Holder | |Balance Owed | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |Totals if needed | | | | | | | | | | | | |

V. CERTIFICATION

Please read the following and sign the application below. All owners, officers and/or partners must sign this application.

The information provided in this application is accurate to the best of my knowledge. I understand that additional personal and or business information may be requested pursuant to this application, and I give my consent for such information to be provided. I also understand that the lender retains the sole decision as to whether this loan application is approved, denied, or modified. It is my right to accept or decline the loan amount, rate, and terms approved by the lender. I understand that credit reports will be obtained in connection with this application and that by my signature permission is granted. Upon my request, I will be informed whether or not credit reports were obtained, and if so, the name and address of the consumer reporting agency that furnished the report.

Name (printed)______________________________ Name (printed)__________________________

Signature:__________________________________ Signature:______________________________

Date:______________________________________ Date:__________________________________

OFFICE USE ONLY

APPROVAL OF APPLICATION

The undersigned Revolving Loan Fund Trustees have examined the application for the Town of Richmond Business Loan described herein including supporting data and finds, the application meets or does not meet the requirements.

LOAN DENIED LOAN APPROVED

$__________________

SIGNATURES DATE:__________________

______________________________

______________________________

______________________________

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Comments/Conditions:___________________________________________________________________________________________________________________________________________________________________

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