Form RD 449-1 RD 449-1 Application for Loan and Guarantee

Form RD 449-1
Rev. 8-97)

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT

FORM APPROVED
OMB NO. 0570-0014

APPLICATION FOR LOAN AND GUARANTEE
(Business and Industry)
General Information:

RD Case Number

The ''Application for Loan and Guarantee'' is to provide information needed for the analysis and loan
determination process. Tear at perforations for case in use. Specific references are made in this application
to sections of the Business and Industrial Loan Instruction. For complete guidance, see RD Instruction
1980-A and 1980-E and related RD forms.

Part A - is to be completed by the proposed borrower. The original and two copies with attachments will be submitted to the proposed
lender.
Part B - is to be completed by the lender. Upon completion, the original and one copy and attachments of Part A and B will be filed
with the RD State Office.
PART A
Instructions to Proposed Borrower: Complete items one through 20. Submit original and two copies of this application and all supporting
documents to the lender. If additional space is required, provide for by an attachment. Additional information may be obtained from any
RD Office.
1. NAME : (Show official name without abbreviations unless the abbreviation is apart of the official name. For proprietor or partnership,
show name(s) followed by d/b/a and trade name used, if any, and attach a copy of the partnership agreement).
Street

City

State

ZIP Code

Project Location: City
Franchise

Yes

County

Telephone Number

Amount of Loan Requested

Population (Last Census)
No

County

If Yes, submit copy

2. TYPE OF BUSINESS:

Applicant's Tax Identification Number

3. THIS PROJECT IS:
A new business venture
A new branch of facility
Refinancing debts

State

SIC Number

Date Enterprise Established
Other (Explain)
An expansion of an existing facility
Transfer of Ownership

4. VETERAN - For individual or partner indicate if veteran
If yes, indicate service from
to

Yes

No

Branch

5. CITIZENSHIP - Do you meet the citizenship requirements in RD Instruction 1980.403?

Yes

No

6. HISTORY OF BUSINESS - Provide a brief description and history of the business (attach additional sheets if necessary).

7. COMMUNITY BENEFITS - Comment on the benefits the community will receive if the loan is made (i.e., taxes, jobs and any
other benefits).

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 0570-0014. The time required to complete this information is estimated to average 70 hours per response, including the time for reviewing instructions,
searching existing data source, gathering and maintaining the data needed and completing and reviewing the collection of information.

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8. PREVIOUS FEDERAL, STATE, OR LOCAL FINANCING - List assistance received, requested, or any pending applications.
(Include direct, participation, insured, or guarantee loans and grants from any Federal, State, or local sources).

9. LITIGATIONS - List details of any pending or final disciplinary or legal (civil or criminal) action against the proposed
borrower, guarantors, partners, principal stockholders and directors.

10. NAMES OF ATTORNEYS, ACCOUNTANTS, AND OTHER PARTIES - List the names of all attorneys, accountants,
appraisers packagers, agents, and all other parties (whether individuals, partnerships, associations) engaged by or on behalf of the
proposed borrower (whether on a salary, retainer or fee basis and regardless of the amount of compensation) for the purpose of
rendering professional or other services of any nature whatever to proposed borrower, in connection with the preparation or
presentation of this application to a lender. List all fees or other charges or compensations paid or to be paid for any purpose in
connection with this application or disbursement of the loan whether in money or other property of any kind whatever, by or for the
account of the proposed borrower together with a description of such services rendered or to be rendered with complete
justification for such purposes. NOTE: all fees and charges are subject to RD review approval and may, in some cases, be
paid out of loan proceeds. (See RD Instruction 1980-411 and 1980-414).
Name and Address (Include Zip Code)

Description of Service Rendered or to be
Rendered with Complete Justification

Total Compensation
Agreed to be Paid*

Compensation
Already Paid

*Enter specific dollar amounts or hourly rates. ''Unknown, '' ''Undetermined, '' or other imprecise terms are not sufficient.
11. SUBSIDIARIES AND AFFILIATES - (1) List the name and addresses of all concerns that are subsidiaries, parent organizations,
or affiliates of the proposed borrower, including concerns in which the proposed borrower holds a controlling (but not necessarily a
majority) interest:

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(2) List all other concerns that are in any way affiliated, by stock ownership, management contracts, or otherwise, with the proposed
borrower. The proposed borrower should comment briefly regarding the trade relationship between the proposed borrower and
such subsidiaries or affiliates and if the proposed borrower has no subsidiary or affiliate, a statement to this effect should be made.
Signed and dated balance sheets, operating statements and reconcilement of net worth (all not more than 60 days old) must be
submitted for all subsidiaries, parent organizations, and affiliates in the same manner as required of the proposed borrower.

12. PURCHASE AND SALES RELATIONS WITH OTHERS - Does proposed borrower buy from, sell to or use the services of any
concern in which an officer, director, major stockholder, or partner, or proprietor of the proposed borrower has a substantial interest?
No If ''Yes,'' give names of such officer, director, stockholder, and partners, names of such concerns and explain
Yes
the nature of the transaction(s).

13. RECEIVERSHIP - BANKRUPTCY - Has the proposed borrower or any officer or, partner or director of the proposed borrower,
affiliates or any other concern with which such person has been connected ever been in receivership or adjudicated bankrupt?
No If ''Yes'' give names, dates and details.
Yes

14. DISCLOSURE OF SPECIAL INFORMATION REGARDING PRINCIPALS - (a) List below the names of any RD employees who

are related by blood, marriage, or adoption, or who have any present or have had any past, direct or indirect financial interest in or
association with, the proposed borrower, or any of its partners, officers, directors, principal stockholders including such interest in
other enterprise; (b) When the proprietor, or any partner, officer, director, or their spouse, is an employee of the U.S. Government
including members of the armed forces, detailed information shall be submitted with the application.
Check box(s) if (a) or (b) is not applicable.

(a)

NAMES AND ADDRESS (Include ZIP Code)

(b)

Details of Relationship or Interest

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15. MANAGEMENT - Enter names of (a) all owners, partners, key officers, directors or stockholders and their annual compensation,
including salaries, fees, withdrawals, etc., (b) hired manager, and (c) all other stockholders having 20 percent or more interest in the proposed
borrower. Elected officials and managers on applications for loans from public bodies are excluded. Personal guarantees from major
stockholders or owners having a major interest in a corporation, and all Partners of partnerships usually will be required. If guarantor cannot
provide such guarantee due to existing contractual or legal restrictions, explain in an attachment. Final determinations will be made by the RD.
Attach, in the case of personal guarantee, current financial statements not over 60 days old at time of filing, and for any corporate guarantee,
current financial statements not over 90 days old at time of filing and certified by an officer of the corporation. Additional updated financial
statements may be required depending on processing time.
(a)

(b)

Position
Name

or
Title

(c)

(d)

(e)

(f)

(g)

Guarantee
Offered*
(Yes or No)

Insurance Carried
for Benefit

Personal
Annual
%
Compensation Ownership
$

Outside
Net Worth

$

of Applicant

*If none offered, provide full explanation why guarantee cannot be offered. (See RD Instruction 1980.443 (b)).
16. REGULATORY AGENCIES - List all regulatory agencies (National, State, or Local) which affect this business or project and
explain if there are any pending matters with such regulatory agencies. Indicate if permits, licenses or clearance are necessary and
their status. (See RD Instruction 1980.45 and 1980.451)

17. INSTRUCTION TO PROPOSED BORROWER - Attach to this application the following supporting documents. Reference for
1980-A include section 1980.1 thru 1980. 100 and reference for 1980-E include sections 1980.401 thru 1980.500:
(a) Comments from state and local governments, if not already submitted. (See RD Instruction 1980.451 (f) (8)).
(b) Form RD 449-4, ''Statement of Personal History,'' if not already submitted. (See RD Instruction 1980.451 (f) (3)).
(c) Form RD 449-22, ''Certification of Non-Relocation and Market and Capacity Information, if applicable. (See RD Instruction
1980.412 (C) AND (D)).
(d) Financial data for new or existing businesses are required in accordance with RD Instruction 1980.451 (i) (7) and (8).
(e) Aging of accounts receivable and payable. (Use 30, 60, 90 days with individual account explanation of items over 90 days old).
(See RD Instruction 1980.451 (i) (15)).
(f) For companies listed on major stock exchanges and subject to the Securities and Exchange Commission regulations, a copy of
the latest SEC 10K report. (See RD Instruction 1980.451 (i) (16)).
(g) Provide supporting documentation for your projections, including economic factors, markets, management, etc. For loans in
excess of $1 million see RD Instruction 1980.442.
(h) If construction is involved, (See RD Instruction 1980.451 (i) (11)). Final plans and specifications must be submitted to the
lender for approval prior to the commencement of construction. Architectural or engineering plans, if applicable, need be
(See RD Instruction 1980.451 (i) (4) and 1980.454 (d)).
(i) If construction is involved, provide applicable equal opportunity and nondiscrimination forms. (See RD Instruction 1980.41).
(j) Form RD 449-10, ''Applicant's Environmental Impact Evaluation.'' (See RD Instruction 1980.40 and 1980.451 (i) (3)).

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(k) Evidence whether the project is located in a flood or mudslide hazard area. (See RD Instruction 1980.42 and 1980.451 (i) (17)).
(1) Provide a written statement of effect project would have on Historic Places, if any. (See RD Instruction 1980.44 and
1980.451 (i) (15)).
(m) If application is for health care facility, attach a ''Certificate of Need,'' from appropriate regulatory agency having jurisdiction
over the project. (See RD Instruction 1980.451 (k)).
(n) If loan is in excess of $100,000, provide certification and notices as required for the Clean Air Act and Water Pollution Control
Act. (See RD Instruction 1980.43).
(o) Document utilities availability with letter of commitment from utilities, energy, water, sewer, fire and police protection.
(p) For all persons listed under MANAGEMENT, item 15, provide a brief description of education, technical training,
employment and business experience (resumes may be used).
(q) Provide a detailed debt schedule correlated to the latest balance sheet reflecting the name of the creditors, loan purpose,
original loan amount and loan balance, date of loan, interest rate, maturity date, monthly or annual payments, payment
status and collateral that secures such loans. You may use Form RD 449-29 Attachment 1.
18. POLICY AND REGULATIONS CONCERNING REPRESENTATIVES AND THEIR FEES:

(a) A proposed borrower may obtain the assistance of any attorney, engineer, appraiser, or other representative to aid it in the
preparation of its application, however, such representation is not mandatory. In the event a loan is approved, the services of
an attorney may be necessary to assist in the preparation of closing documents, title examination, etc.
(b) There are no ''authorized representatives'' of RD, other than our regular salaried employees. Payment of any fee or gratuity to
RD employees is illegal and will subject the parties to such a transaction to prosecution.
(c) RD will not approve placement or finder's fees for the use or attempted use of influence in obtaining or trying to obtain a loan.
(d) Fees which will be approved will be limited to reasonable sums for services actually rendered in connection with the application
or the closing, based upon the time and effort required, and the nature and extent of the services rendered by such representative.

(e) It is the responsibility of the proposed borrower to set forth in Section 10 of this application the names of all persons or firms
engaged by or on behalf of the proposed borrower. Proposed borrowers are also required to advise RD in writing of the names and fees of
any representatives engaged by the proposed borrower subsequent to the filing of the application. Failure to so notify RD constitutes
''misrepresentation'' and will cause RD to contest the guarantee if lender had knowledge of this omission.
(f) Any proposed borrower having any question concerning the payment of fees, or the reasonableness of fees, should communicate
with RD before the application is filed for a loan guarantee.

19. AGREEMENT OF NONEMPLOYMENT OF RD PERSONNEL. In consideration of RD guaranteeing any part of the loan applied
for in this application, the proposed borrower hereby agrees with RD that proposed borrower will not for a period of two years after
date of guarantee of any part of the loan, employ or tender any office or employment to, or retain for professional services, any person
who, on the date of such disbursement, or within one year prior to said date, (a) shall have served as an officer, attorney, agent, or
employee of RD and (b) as such, shall have occupied a position or engaged in activities which RD shall have determined, or may
determine, involved discretion with respect to the granting of assistance under the Consolidated Farm and Rural Development Act
and other acts administered by RD from time to time.
20. CERTIFICATION - The proposed borrower hereby certifies that:
(a) The Proposed borrower has read RD policy and regulations concerning representatives and their fees (18 above) and has not
paid or incurred any obligation to pay, directly or indirectly, any fee or other compensation for obtaining the loan hereby
applied for other than for services and expenses authorized pursuant to paragraph 18 above.
(b) The proposed borrower has not paid or incurred any obligation to pay any Government employee or special Government
employee any fee, gratuity or anything of value for obtaining the assistance hereby applied for. If such fee, gratuity, etc. has
been solicited by any such employee, the proposed borrower agrees to report such information to the Office of Inspector
General, USDA, Washington, D.C. 20250.
(c) Information contained above and in exhibits attached hereto are true and complete to the best knowledge and belief of the
proposed borrower and are submitted for the purpose of requesting RD to guarantee a loan by a lender to the proposed borrower.
Whether or not the loan herein applied for is approved, the proposed borrower agrees to pay or reimburse the lender for the cost
of any surveys, title or mortgage examinations, appraisals, etc., performed by nonlender personnel with consent of the proposed
borrower.
(d) The proposed borrower hereby covenants, promises, agrees and gives herein the ASSURANCE that in connection with any loan
to the proposed borrower which RD may guarantee as a result of this application, it will COMPLY with the requirements of
Executive Order 11245 regarding Equal Credit Opportunity. Proposed borrower further agrees that in the event it fails to comply
with said applicable provision, RD may cancel, terminate, accelerate repayment of or suspend in whole or in part the financial
assistance provided or to be provided by RD, and that RD or the United States Government may take any other action that may
be deemed necessary or appropriate of this ASSURANCE OF COMPLIANCE.

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These requirements prohibit discrimination on the grounds of race religion, color, sex, marital status or national origin
recipients of Federal financial assistance, including but not limited to employment practices and require the submission of
appropriate reports and access to books and records. These requirements are applicable to all transferees and successors in
interest.
NOTICE:
In accordance with 5 U.S.C. 552a, the Privacy Act of 1974, any individual should be provided a copy of Form
RD 410-9, ''Statement Required by the Privacy Act,'' at the time this application is completed.
The proposed borrower hereby agrees to provide the lender and RD timely periodic financial statements including the annual financial
statement required by RD Instruction 1980.451 (i) (13). Failure to provide such reports will be considered a default of the loan in
accordance with Form RD 449-35, ''Lender's Agreement,'' which is a part of Subpart E of Part 1980, Title 7 CFR.
WARNING: Section 1001 of Title 18, United States Code provides: ''Whoever, in any matter within the jurisdiction of any
department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick,
scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or
makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent
statement or entry, shall be fined under this title or imprisoned not more than five years, or both.
Misrepresentation of material facts may also be the basis for denial of credit by the Rural Development.

*Proposed Borrower Name:

By

CORPORATE SEAL

Title
Attest:

Date Signed:
Proposed Borrower's Contact Person
(Title)

Name

Address

Telephone

*(Individual, general partner trade name, or
corporation name).

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PART B
INSTRUCTIONS: Lender completes item 21 through 33 and submits the original and one copy of this application and all supporting
documents to RD.

21. REQUEST FOR GUARANTEE:
LENDER TAX IDENTIFICATION
(For use only by lender)
NO.
We propose to make and service a loan to the proposed borrower named on page 1 of this application. We request an RD loan guarantee
subject to the provisions of the applicable RD Instructions.
22. TERMS AND CONDITIONS OF LOAN:
Amount
(1) Type

Percent of Guarantee Requested
Terms (yrs.)
Interest*
Monthly Payments

Real Estate
Machinery and Equipment
Working Capital
Other
TOTAL

yrs.
yrs.
yrs.
yrs.
$0.00

$0.00

*If the variable rate, follow by a "v" and identify base rate used and what interest differential is added to base rate. If multirates are used
provide overall effective interest rate for the entire loan:
%. NOTE: Guaranteed borrower must have the
right to prepay their loans. Prepayment penalties are permitted if reasonable and approved by RD. Attach amortization schedule for loan.
23. (a) SOURCE AND USE OF FUNDS: Loan funds will be disbursed and used for the following purposes, in the following amounts.
Building and Improvements
Land and Rights
Fees (List below)
Legal and Engineering Fees
Interim Interest

Machinery and Equipment
Contingencies
Debt Refinancing*
Working Capital
Other (Specify)

$0.00
* Attach complete justification for the request (Include long and short term debt)
(b) Describe in detail the source and use of funds from (a) above and any other source of funds for the project and its amount and
indicate whether the amounts and sources are proposed or
24. COLLATERAL AND LIEN POSITION: Describe collateral in detail, show whether now owned or to be acquired. (Use Form RD
449-2 with appropriate appraisal reports and indicate any prior liens that may exist on the collateral).

25. PLANNED DISBURSEMENTS: Record plans for distributing the loan. (See RD Instruction 1980.60 and 1980.454)

26. (a) PERSONAL AND/OR CORPORATE GUARANTEES RECOMMENDED: (See RD Instruction 1980.443)
(b) COLLATERAL OFFERED FOR PERSONAL AND/OR CORPORATE GUARANTEES:

27. INSURANCE: List requirements for Life, Hazard, Federal Flood, and Liability.

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28. COMMENTS OF LENDER: (Attach additional sheets, if necessary).
(a) Evaluate proposed borrower's management, past record, repayment ability and other financial analysis.

(b) State whether any officer, director, stockholder, or employee of the lender has a financial interest in the proposed borrower or
vice versa. If so, give details:

(c) Is proposed borrower indebted to lender?

Yes

No

If yes, provide history of debt repayment and other details:

(d) List all fees and charges for the loan, including those for preparation of application, servicing, etc. Indicate whether the
guarantee fee will be passed on to proposed borrower. (See RD Instruction 1980.411 and 1980.414).

(e) Provide loan servicing plans, including field inspections, frequency of obtaining periodic and annual financial statements and
their analysis, use of correspondents or other outside consultants, location of office servicing the loan, and complying with
servicing responsibilities set forth in the ''Lender's Agreement,'' Form RD 449-35.

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29. LOAN AGREEMENT: Attach proposed lender and borrower loan agreement (See RD Instruction 1980.451 (i) (13)).
30. LENDER'S EXPERIENCE WITH RD:
(a) Have you made any loans guaranteed by RD?
If yes, check program area:
Farmer Programs

Yes
No
Rural Housing

Business and Industry.

(b) If proposed borrower has or had a loan(s) with you, has such loan(s) appeared in regulatory examination report?
Yes
No
If yes, explain.

(c) Have you ever been debarred from participation in RD programs? If yes, explain.

31. Verify and comment on proposed borrower's debt schedule:

32. PLANS FOR CONSTITUTING THE LOAN: (See Form RD 449-35, ''Lender's Agreement," paragraph III A).
(a) Will retain entire loan
Yes
No
(b) Will utilize secondary market for guaranteed portion (indicated by check).
Assignment
Participation
Multi-note
(c) Participation of unguaranteed portion

Yes

No

(Lender must retain 5% of the unguaranteed portion of loan in its portfolio).

33. OPINION: In our opinion, the loan has repayment ability, appears feasible and all RD requirements in RD Instruction 1980-A and
1980-E will be met.
WARNING: Section 1001 of Title 18, United States Code provides: ''Whoever, in any matter within the jurisdiction of any
department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick,
scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or
makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent
statement or entry, shall be fined under this title or imprisoned not more than five years, or both.
Misrepresentation of material facts may also be the basis for RD not issuing a Loan Note Guarantee.

LENDER:

Contact Person:
Telephone Number:
Date:

By

Authorized Officer
Title