SBA Form 1920 SX (Part B). - Small Business Administration

OMB Control No.: 3245-0348Expiration Date: 1/31/2014Supplemental Information for <strong>SBA</strong> Express, Export Express, <strong>Small</strong> Loan Advantage, Pilot LoanPrograms and PLP Processing (to be completed by lender)<strong>SBA</strong> Express (Revolving: Yes No) Patriot Express (Revolving: Yes No) Export Express ( Revolving: Yes No )<strong>Small</strong> Loan AdvantagePLP (IT: Yes No EWCP: Yes No CAPlines:- If yes, Seasonal Builders Contract Working Capital )<strong>Small</strong> <strong>Business</strong> Borrower Name: ____________________________________________________________ Sole Proprietorship <strong>Part</strong>nership Corporation LLC OtherTrade Name (dba):Borrower Contact: Mr Ms First MI LastBorrower Street:Borrower City:Borrower State :Borrower Phone #Borrower Tax ID #:Borrower County:(2 letter abbrev.) Borrower Zip Code:#Owners SS #: 1. 2.Lender Name:(if available)Lender ID #:(if no trade name, enter “NA”)L oan Amount: $______________ <strong>SBA</strong> Guaranty % ________ Loan Term in # of Months:_________Interest Rate: Prime rate* = _______ + Spread ______ = Variable Interest Rate: _______ Variable FixedLIBOR (1 month) + 3.0% * = _______ + Spread ______ = Variable Interest Rate: ________<strong>SBA</strong> Peg Rate * = _______ + Spread ______ = Variable Interest Rate: ________Fixed Base Rate* = _______ + Spread ______ = Fixed Interest Rate: ________*in effect on the first business day of the month as identified in a national financial newspaper or <strong>SBA</strong> publicationExporter? Yes No If yes, amount in export sales applicant has projected loan will support $___________ New <strong>Business</strong> (2 years or less) Existing <strong>Business</strong> (more than 2 years old) Change of Ownership*** All Outstanding <strong>SBA</strong> Loans: _________________________ Loan is Collateralized Rural Urban (business location)NAICS Code: ________________ New Construction? If checked, amount: $_________________# of employees prior to loan # of jobs created because of loan # of jobs retained because of loanFranchiseFranchise Name: ___________________________________Veteran** 1=Non-Veteran; 2=Veteran-Other; 3=Service-Disabled Veteran; 4=Not Disclosed.Patriot Express* Codes on next page. Each eligible owner must be identified with one of these codes.Gender** M=Male; F=Female; N=Not DisclosedRace**1=American Indian or Alaska Native; 2=Asian; 3=Black or African-American; 4=Native Hawaiian or PacificIslander; 5=White; X=Not DisclosedEthnicity** H=Hispanic or Latino; N=Not Hispanic or Latino; Y=Not DisclosedOwner # % Owned * Veteran Patriot Exp.* Gender Race Ethnicity Please reference the above codes tocomplete this table for each 20% or greaterowner of the applicant business. Morethan one race may be selected.Were any other <strong>SBA</strong> loans with <strong>SBA</strong> Loan # <strong>SBA</strong> Loan <strong>SBA</strong> Termmaturities of more than 12 months made Approval Date Amount Guaranty % (in months)to the borrower in the last 90 days?If so, please complete for each loan<strong>SBA</strong> <strong>Form</strong> <strong>1920</strong><strong>SX</strong> (<strong>Part</strong> B) (Revised 5/12) Page 1 of 3

Supplemental Information for <strong>SBA</strong> Express, Export Express, SLA, Pilot Loan Programs andPLP ProcessingBorrower Name:Use of Loan ProceedsAmount (Total Dollars)Purchase Land only $Purchase Land and Improvements $Purchase Improvements only $Construct a Building $Add an Addition to an Existing Building $Make Renovations to an Existing Building $Pay Off Interim Construction Loan $Pay Off Lender’s Interim Loan $Leasehold Improvements $Purchase Equipment $Purchase Furniture and Fixtures $Purchase Inventory $Pay Trade or Accounts Payable $Pay Notes Payable – not Same Institution Debt $Pay Notes Payable – Same Institution Debt $Purchase <strong>Business</strong> (Change of Ownership) – ***Complete Page 3 $Refinance <strong>SBA</strong> Loan – not Same Institution Debt $Refinance <strong>SBA</strong> Loan – Same Institution DebtWorking Capital $<strong>SBA</strong> Guaranty Fee $Other – Explain _____________________________ $Total $*Eligibility Categories for Patriot Express loans only (Mandatory for eligibility purposes):2=Veteran other than service-disabled (dishonorably discharged not eligible)3=Service-disabled Veteran5=Active Duty military eligible for the Transition Assistance Program6=Reservist or National Guard member7=Current spouse of any of the four groups listed above; or current spouse of any Active Duty military8=Widowed spouse of a service member or veteran who died of a service-connected disabilityFor Patriot Express loans, Patriot Express eligible owners must equal at least 51 percent of the total ownership in the “Owner” block on Page 1.** The gender/race/ethnicity/veteran data (except as described for Patriot Express) is collected for statistical purposes only.Disclosure is voluntary and has no bearing on the credit decision.Lender Contact: Mr Ms First MI LastLender Contact Phone #: Lender Contact Fax #:<strong>SBA</strong> <strong>Form</strong> <strong>1920</strong><strong>SX</strong> (<strong>Part</strong> B) (Revised 5/12) Page 2 of 3

***Complete the following for a Change of Ownership of the <strong>Business</strong>Total Dollar AmountTotal Amount Paid to Seller $Sources:7(a) Loan $Seller Financing – Amt. on full standby for at least 2 yr. $– Amount not on full standby $Buyer’s Equity Contribution: Cash Describe source: ____________________ $ Borrowed $ Other Describe: ________________________ $Assets Purchased: (Net Book Value except whereindicated)Accounts Receivable $Inventory $Real Estate $Check one: Book Value Appraised ValueMachinery and Equipment $Check one: Book Value Appraised ValueFurniture and Fixtures $Intangible Assets** $Other: Describe _____________________ $**Breakdown of Intangible Assets (if available):Covenant not to compete $Customer/client list $License (liquor, FCC, etc) $Franchise rights, patents, trademarks, etc. $Goodwill $Other: Describe _____________________ $Complete the following when an Independent <strong>Business</strong> Valuation is required by SOP 50 10 5:Appraiser’s Conclusion or Summary of Value: $________________________________________Name of <strong>Business</strong> Appraiser (person): __________________________________ Fee: $____________Check qualification(s) of the Appraiser: Accredited Senior Appraiser (ASA) Certified <strong>Business</strong> Appraiser (CBA) Accredited in <strong>Business</strong> Valuation (ABV) Certified Valuation Analyst (CVA) Accredited Valuation Analyst (AVA) Certified Public Accountant (CPA) that performs the business valuation in accordance with the“Statement on Standards for Valuation Services”Will a business broker receive a commission from the sale of the business? Yes NoIf yes: Name of <strong>Business</strong> Broker (person): _________________________ Commission: $____________Address: _________________________________________________________________________NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays a currentlyvalid OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions, gathering data needed, andcompleting and reviewing the form is 15 minutes per response. Comments or questions on the burden estimates should be sent to U.S. <strong>Small</strong><strong>Business</strong> <strong>Administration</strong>, Chief, AIB, 409 3rd St., SW, Washington DC 20416. PLEASE DO NOT SEND FORMS TO THIS ADDRESS.<strong>SBA</strong> <strong>Form</strong> <strong>1920</strong><strong>SX</strong> (<strong>Part</strong> B) (Revised 5/12) Page 3 of 3