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Capital Access Program (CAP) Refinance Line of Credit

Lender Information:

Lender Institution:

Loan #:

CAP Program Information:

1. Loan Type:

2. Loan Term:

Years: | Execution Date:

3. Business/Borrower Information:

a. Borrower Legal Name
b. Address
c. County
d. NAICS Code/Industry
e. Year Business Started
f. Gross Revenues (last fiscal year)

4. New Loan Information:

a. Gross Principal Amount:

b. Amount Eligible for Coverage:

c. Amount to be Covered:

5. Exisiting CAP Loan Information

a. Original Amount Covered:

b. Total Coverage Increase:

6. Computation of CAP Reserve Payments and CAP Security Deposit:

a. Total Lender/Borrower Percentage (between 3% and 4%):

b. Amount of NEW Loan to be Covered (equal to 5d):

c. Total Reserve Fund Payment (6a*6b):

d. Lender Portion (25% of 6c, can be charged to borrower):

e. Borrower Portion (6c-6d):

f. BFA Security Deposit (5c*2.5):

7. Additional Amount (if any) Contemporaneously Loaned to Borrower:

8. Employment Information:

a. Number of NH Employees:

b. Estimate of Jobs Retained:

c. Estimate of Jobs Created:

d. The average number of hours per week that a part-time employee works

e. The average number of hours per year that a seasonal employee works

Full Time: Part Time: Seasonal:

Hours:

By executing this Loan Filing Form and submitting this Loan for enrollment, the Lender hereby makes the representations and warranties required to be made under Paragraph 4 of the Lender Participation Agreement, including:

The Lender has not made the Eligible Loan in order to place, under the protection provided by the Program, prior debt that is not covered under the Program and that is or was owed by the borrower to the Lender or to an Affiliate of the Lender.
The Lender has not made the Eligible Loan as a refinancing of a loan (other than an existing Enrolled Loan) previously made to the Borrower by the Lender or an Affiliate of the Lender.
The Lender is not attempting to enroll the unguaranteed portions of SBA guaranteed loans.
The Lender has disclosed to the Borrower information concerning the Program as set forth on the Notice to Borrower.
No Principal of the Lender has been convicted of a sex offense against a minor (as such terms are defined in section 111 of the Sex Offender Registration and Notification Act (42 U.S.C. § 16911)). For the purposes of this Certification, Principal means the following: if sole proprietorship, the proprietor; if a partnership, each managing partner and each partner who is a natural person and holds 20% or more ownership in the partnership; and, if a corporation, limited liability company, association or development company, each director, each of the five most highly compensated executives or officers of the entity, and each natural person who is a direct or indirect holder of 20% or more of the ownership stock or stock equivalent of the entity.
The Lender is in compliance with the requirements of 31 C.F.R. § 1020.220, customer identification requirements for banks.

Date: