Sba Form 4 - Application For Business Loan Page 3
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4AGREEMENTS AND CERTIFICATIONS
7. Submit the names, addresses, tax I.D. number (EIN or SSN), and
AGREEMENTS
current personal financial statement of any co-signers who are not
By signing below you agree to the following:
otherwise affiliated with the business and any guarantors for the loan
not covered by 3. above. Exhibit F.
(a) Agreements of non-employment of SBA Personnel. I agree that
if SBA approves this application I will not, for at least two years,
8. Include a list of any machinery or equipment or other non-real estate
hire as an employee or consultant anyone that was employed by the
assets to be purchased with loan proceeds and the cost of each item
SBA during the one year period prior to the loan disbursement.
as quoted by the seller. Include the seller's name and address. Exhibit G.
(b) Waiver of Claims. As consideration for any Management,
Technical, and/or Business Development Assistance that may be
9. Have you or any officer of your company ever been involved in
provided, I waive all claims against SBA and its consultants.
bankruptcy or insolvency proceedings?
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Yes
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No
If yes, please provide the details as Exhibit H.
(c) Criminal Background. I authorize the SBA's Office of Inspector
General to request criminal record information about me from
10. Are you or your business involved in any pending lawsuits?
criminal justice agencies for the purpose of determining my
eligibility for assistance under the Small Business Act.
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Yes
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No
If yes, provide the details as Exhibit I.
(d) Reimbursement of Expenses. I agree to pay for or reimburse
11. Do you or your spouse or any member of your household, or anyone
SBA for the cost of any surveys, title or mortgage examinations,
who owns, manages, or directs your business or their spouses or members
appraisals, credit reports, etc., performed by non-SBA personnel
of their households work for the Small Business Administration, Small
provided I have given my consent.
Business Advisory Council, SCORE or ACE, any Federal Agency, or the
(e) Reporting. I agree to report to the SBA Office of the Inspector
participating lender?
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If yes, please provide the name
Yes
No
General, Washington, DC 20416 any federal government employee
and address of the person and the office where employed.
who offers, in return for any type of compensation, to help get this
Label this Exhibit J.
loan approved.
12. Does your business, its owners of majority stockholders own or have
READ THE FOLLOWING CAREFULLY -- FALSE STATE-
a controlling interest in other businesses?
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Yes
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No
MENTS ARE SUBJECT TO CRIMINAL PROSECUTION:
If yes, please provide their names and the relationship with your company
along with financial data requested in question 4.
Label this Exhibit K.
If you knowingly make a false statement, you can be fined up to
$250,000 and/or imprisoned for not more than five years under
13. Do you buy from, sell to, or use the services of any concern in which
18 USC 1001; if submitted to a Federally insured institution,
someone in your company has a significant financial interest?
under 18 USC 1014 by Imprisonment of not more than twenty
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Yes
No
If yes, provide details on a separate sheet of
years and/or a fine of not more than $1,000,000.
paper. Exhibit L.
CERTIFICATIONS:
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14. Is your business a franchise?
Yes
No
If yes, include
By signing below you certify as to the following:
a copy of the franchise agreement and a copy of the FTC disclosure
(a) All information in this Application and the Exhibits is true
statement supplied to you by the Franchisor. Label this Exhibit M.
and complete to the best of your knowledge.
You understand that
this information is being submitted to a lender and SBA so they can
decide to make a loan or give a loan guaranty, and that the lender
CONSTRUCTION LOANS ONLY
and SBA are relying on this information.
15. Include as a separate exhibit the estimated cost of the project and
(b) You have not paid anyone employed by the Federal Government
a statement of the source of any additional funds. Label this Exhibit N.
for help in getting this loan. You understand that you do not need to
pay any other third-party for assistance in locating a lender or
preparing this Application or Exhibits, and you certify that you will
16. Provide copies of preliminary construction plans and specifications.
disclose all parties that were paid for such assistance
to the
Label this as Exhibit O. Final plans will be required prior to
Lender and will complete the SBA Form 159 for all such persons.
disbursement.
(c) I have read a copy of the "Statements Required By Law And
EXPORT LOANS
Executive Order," which is attached to this application and agree to
comply with the requirements in this Notice.
17. Does your business currently export, or will it start exporting,
pursuant to this loan (if approved)?
Check here:
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Yes
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No
If Applicant is a proprietor or general partner, sign below.
18. If you answered yes to item 17, what is your estimate of the total
By:
export sales this loan would support?
$
19. Would you like information on Exporting?
If Applicant is a Corporation, sign below:
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Check here:
Yes
No
COUNSELING/TRAINING
Date
Corporate Name and Seal
20. Have you received counseling or training from SBA (e.g., SCORE,
ACE, SBDC, WBC, etc.)?
Check here:
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Yes
[
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No
By:
Signature of President
SUBMIT COMPLETED APPLICATION TO LENDER OF CHOICE.
Attested by:
Signature of Corporate Secretary
SBA Form 4 (9-09) Previous Edition Obsolete
Page 3
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