Form RD 5001-01 RD 5001-01 Lender's Application

Form RD 5001-1
(00-00)

FORM APPROVED
OMB NO. 0000-0000

Position 3
UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT

LENDER’S APPLICATION
THIS IS AN APPLICATION FOR:
(check one)

APPROVED LENDER STATUS

APPROVED AND PREFERRED LENDER STATUS

PREFERRED LENDER STATUS
2. ADDRESS (Include Zip Code):

1. NAME OF LENDER:

3. LENDER TAX ID NUMBER:

4. LENDER’S PRESIDENT/CEO:

5. CONTACT PERSON:

6. CONTACT TELEPHONE NUMBER
(

)

7. LENDER’S DUNS NUMBER:

8. CONTACT E-MAIL:

9. CONTACT FAX NUMBER:

10.LENDER’S REGULATORY ENTITY:

11.LENDER’S CHARTER STATE:

12.LENDER’S NET WORTH:

13.EXISTING RURAL DEVELOPMENT LOAN
PORTFOLIO:

14. a. LENDER’S TYPE:

15.LENDER’S ROUTING NUMBER:

YES

NO

REGULATED/
SUPERVISED

OTHER
16.LENDER’S WEB URL:

AMOUNT $_____________________

b. If Other is checked, please complete items
17, 18 and 19.

17.LENDER’S LINE OF CREDIT: (to be completed only if “Other” is checked in Item 14)

AMOUNT

CREDIT PROVIDER NAME(S)

CREDIT PROVIDER CONTACT PERSON(S)

PHONE NUMBER(S)

18.LENDER’S LIQUID ASSETS: (to be completed only if “Other” is checked in Item 14) $ __________________________________

19. EXAMINATION CONDUCTED. Has the lending entity undergone an examination pursuant to 5001.9(c)(1)(iv): (to be completed only if “Other” is
checked in Item 14)
YES
NO

ATTACH THE FOLLOWING IF NOT ALREADY SUBMITTED:
20. A written summary of the lender’s origination policies and procedures, as required under § 5001.9(a)(1), including, at a minimum, its
internal credit review process; underwriting process, including a sample credit evaluation project summary; and exceptions to its
origination loan policies and procedures and other information relevant to Agency guaranteed loans.
21. A written summary of the lender’s servicing policies and procedures, as required under § 5001.9(a)(1), including, at a minimum, its
portfolio management; delinquent loan handling; liquidation process; releases; termination; final loss claims; and exceptions to its
servicing loan policies and procedures and other information relevant to Agency guaranteed loans.
22. Lender’s Current Audited Financial Statements, as required under § 5001.9(b)(1)((iii)(H) and § 5001.9(c)(2)(H).
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0000-0000. The time required to complete this information is estimated to average 4 - 24 hours per responsee, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Form RD 5001-1 Page 1 of 2

23. Description of its lending history and experience, including, as specified under 5001.9(b)(1)(iii) and 5001.9(c)(2)(v), evidence of
demonstrated expertise in loan origination, making, securing, servicing, and collecting loans; length of time in the commercial lending
business; experience with government guaranteed lending, particularly within any of the subject programs; the range and volume of
lending and servicing activity; the current status of the loan portfolio; the lender’s commercial loan fee structure; and the level of
experience of the lender’s management, lending, and servicing staff.
24. For lenders that are non-regulated/non-supervised lenders:
(a) evidence showing that the lender has the necessary capital, resources, and funding capacity to successfully meet its
responsibilities, as required under § 5001.9(c)(2)(ii);
(b) Copies of any license, charter, or other legal authority to engage in the proposed loan making and servicing activities, as required
under § 5001.9(c)(2)(iii).
(c) documented sources of funds for funding and closing loans, as required under § 5001.9(c)(2)(vi);
(d) office location(s) and proposed lending area(s), as required under § 5001.9(c)(2)(vii); and
(e) results of the examination required § 5001.9(c)(1)(iv), as required under § 5001.9(c)(2)(viii).
25. Lenders applying for preferred lender status, as provided under § 5001.9(d):
(a) documentation to support compliance with the criteria for preferred lender status, as specified in § 5001.9(d)(1); and
(b) a list of each State in which the lender desires to receive preferred lender status and the branch offices for which the lender desires
to be considered by the Agency for approval, as required under § 5001.9(d)(2).

GENERAL LENDER CERTIFICATION
Lender certifies that it has reviewed the General Lender Certifications contained in this application. Lender’s signature represents its
agreement to comply with the limitations outlined in the General Lender Certifications.
Lender certifies that no pending or active discrimination lawsuit(s) have been filed against it alleging violation of the requirements
and provisions of Title VI of the Civil Rights Act.
Lender certifies that it meets all the criteria to be considered for the Lender status it is requesting. (Pursuant to 7 CFR 5001.9.)
If the Lender is a regulated or supervised Lender, Lender certifies that it is in good standing with its regulator. If the Lender is a nonregulated/non-supervised Lender, Lender certifies that it is in good standing in each state in which the Lender is licensed and intends
to conduct business.
Lender certifies that it has not been debarred or suspended.
Lender certifies that it maintains an internal audit and management control system for the evaluation and monitoring of the overall
quality of its loan origination and servicing activities.

Lender’s Name

Date

By:
Officer Signature

Officer Title

Form RD 5001-1 Page 2 of 2