Repowering Assistance Program - Individuals

Instructions for RD Form 4288-05

Repowering Assistance Program � Agreement

This form must be submitted to the appropriate office to process payment for Repowering Assistance.

Prepared by the Agency.� Submit the one original.

Original should be signed by the Agency approval official and awardee.� The Original to appropriate USDA RD Energy Division in Washington DC

Applicants must complete portions of Item 2-4.

Fld Name / Item No.	Instruction
1. Name of Biorefinery	Enter name.
2.� Mail Address	Enter mailing address.
3.� Contact Person Name	Enter contact person name.
4. Contact Person Title	Enter contact person title.
4. IRS Tax Identification Number of Producer	Enter the contact person tax identification number of producer.
5. DUNS Number	Enter contact person DUNS number.
6. Telephone Number	Enter contact person telephone number.
7. Fax �No.	Enter contact person fax number.
8. E-Mail Address	Enter contact person email address.
9. Total Payment Amount	Enter the total payment amount.

Part C: program Address and Phone Number

Fld Name / Item No.	Instruction
1. Agency Address/Fax Number	Enter the address agency address and fax number.
3. Electronic Transfer Funds Information	Enter the Bank name, routing number and account number.�

Part I: Certification And Acceptance

Fld Name / Item No.	Instruction
1a. Biorefinery Name	Enter biorefinery name.
1b.	Signature Field
1c. Title	Enter the person who will sign document title.
1d. Date	Enter the date.
2a.	Signature Field
2b. Date	Enter the effective date.