$DL Application

Application to Participate in

Pilot Study of Small Dollar Loan Programs

Institution Name, Certificate number and Address:

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Name, Title/Telephone Number of Institution Contact:

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1. Provide a program description explaining the current or proposed structure of your institution’s small-dollar loan program, addressing each of the following program components:

   1. the current or projected dollar size of the program;

   2. plans to market the program;

   3. the application process and underwriting standards;

   4. interest rates;

   5. fees (please describe, if applicable, how fees relate to actual costs incurred);

   6. prepayment penalties, (please describe if applicable);

   7. automatic savings component or incentives, (please describe if applicable)

   8. loan amortization period for:

      1. closed end credit transactions; and

      2. open end credit transactions.