Storm Recovery Loan Program

Loan Application

Financing from $500 to $25,000

UCEDC, a nonprofit economic development corporation 75 Chestnut Street, Cranford, New Jersey 07016

T: 908.527.1166 F: 908.527.1207 email: info@ucedc.com www.ucedc.com

Program Description

The Storm Recovery Loan program, supported by Investors Bank and the HurricaneSandy New Jersey Relief Fund, is designed to provide immediate working capital at below-market rates to small businesses affected by Tropical Storm Sandy. These specially designated loans range from $500 to $25,000 and can be used for any of the following purposes: the purchase of supplies or inventory; machinery or equipment; expansions or renovations on owned commercial real estate; or working capital. Applicants are asked to complete the attached forms that include a business loan application and personal financial statements. Other related documentation may be requested. Once the application is deemed complete, a decision will be made within two weeks. Please contact us if you need assistance preparing for or completing the loan application.

UCEDC is an equal opportunity employer and is committed, in policy and in practice to recruit, hire, train, and promote, in all job classifications, without regard to race, color, religion, sex

sexual orientation, age, national origin, marital status, or status as a veteran. Our commitment to diversity extends beyond each employee

to include every client, business partner and the community in which we live and work.

STORM RECOVERY LOAN APPLICATION

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STORM RECOVERY LOAN APPLICATION UCEDC wants to make your loan application as easy as possible. We have trimmed the amount ofinformation required to the minimum and have sought to make every form simple and clear. We assure you that all the information requested is essential in order to process your credit request quickly. Your complete application should include the following:

Business Loan Application Personal Financial Statement(s) (included in application Personal Cash Flow Statement (included in application) Two Years Personal Federal Tax Returns Two Years Complete Business Tax Returns Current Interim Financial Statements Management Resume (included in application) Copy of lease, if applicable

Please read the following information release statement and sign: I/we authorize and instruct any person or consumer reporting agency to compile and furnish to UCEDC any information it may have or obtain in response to such credit inquiries and agree that same shall remain your property whether or not credit is extended. All information set forth in this application is declared to be a true representation of facts made for the purpose of obtaining the credit requested and any willful misrepresentation on this application could result in criminal action. UCEDC may request a consumer (Experian, Trans Union, Equifax, etc) or business (Dun & Bradstreet) report in connection with this application and subsequent consumer and/or business reports in connection with updating, renewing or extending the existing or future extensions of credit. Upon your written request, we will provide the name and address of the consumer agency furnishing such reports to us, if any. BUSINESS NAME: DATED: BY:

TITLE YOUR SIGNATURE:

PRINCIPAL, INDIVIDUALLY

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STORM RECOVERY LOAN APPLICATION –Page 2

LOAN REQUEST REFERRED BY: ________________________________________________ AMOUNT REQUESTED: $ TOTAL PROJECT COST:$ PURPOSE OF LOAN:

BUSINESS RECORDS BUSINESS NAME: BUSINESS ADDRESS: TELEPHONE NUMBER: FAX NUMBER: PLEASE CHECK ONE: REGULAR CORPORATION SOLE PROPRIETORSHIP LLC S CORPORATION NON-PROFIT CORP. OTHER DATE ESTABLISHED: TAX ID NO. TYPE OF BUSINESS: NAME & ADDRESS OF CURRENT BANK:

PHONE NUMBER: ACCOUNT NUMBER:

ACCOUNTANT: PHONE NUMBER:

LANDLORD/MORTGAGE COMPANY NAME:

PHONE NUMBER: ANNUAL RENT $:

LEASE EXPIRATION DATE:

STATE A BRIEF HISTORY AND DESCRIPTION OF THE BUSINESS:

NUMBER OF EMPLOYEES: AT PRESENT AFTER LOAN

FULL-TIME __________ ___________

PART-TIME __________ ___________

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STORM RECOVERY LOAN APPLICATION –Page 3

PRINCIPALS, PARTNERS, OFFICERS OR STOCKHOLDERS (please use separate sheet if more than two owners

NAME: NAME:

% OWNERSHIP:____________________________ % OWNERSHIP:________________________________

HOME ADDRESS: HOME ADDRESS:

CITY, ST, ZIP: ____________________________ CITY, ST, ZIP: _________________________________

PREV. ADDRESS: PREV. ADDRESS:

CITY, ST, ZIP: _____________________________ CITY, ST, ZIP: _________________________________

S.S.#: S.S.#:

PHONE: D.O.B.: PHONE: D.O.B.:

TITLE: TITLE:

BANK NAME: BANK NAME:

BANK ACCT#: _____________________________ BANK ACCT#: _________________________________

BUSINESS DEBT SCHEDULE

LIST ANY TERMS OF DEBT & LINES OF CREDIT AS OF MOST CURRENT BUSINESS BALANCE SHEET

PAYABLE TO

INSTITUTION & ACCT#

ORIGINAL

DATE

ORIGINAL

AMOUNT

CURRENT

BALANCE

INTEREST

RATE MATURITY

DATE

MONTHLY

PAYMENT COLLATERAL

CURRENT OR

PAST DUE

STORM IMPACT Please describe the storm’s physical and economic impact on your business: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

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OTHER INFORMATION

Are there any outstanding judgments, garnishments or other legal proceedings against you or your business?

If so, please explain:

Have you or your business ever declared bankruptcy? YES NO

Have you or your business ever had a judgment against you? YES NO

Are any assets pledged or debts secured except as shown? YES NO

Have you had property foreclosed upon or made a settlement with creditors? YES NO

DEMOGRAHPIC INFORMATION

This information is for statistical purposes only and will not affect your loan decision.

Gender (select one): 100% female owned 51-99% female owned

100% male owned 51-99% male owned

50% male/female owner

Veteran Status (select one): Veteran Service Disabled Veteran Non-Veteran

Ethnicity (select one): Hispanic Not Hispanic/Latino Unknown

Race (select one) Black/African American White Asian

American Indian/Alaskan Native Native Hawaiian/ Other Pacific Islander

The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis

of race, color, religion, nationals origin, sex, marital status, age (provided that the applicant has the capacity to

enter into a binding contract); because all or part of the applicant's income derives from any public assistance

program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection

Act. The Federal agency that administrates compliance with this law concerning this creditor is the Federal

Trade Commission, Equal Credit Opportunity, Room 500, 633 Indiana Avenue, N.W., Washington, DC 20580.

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OMB APPROVAL NO. 3245-0188 EXPIRATION DATE:11/30/2004

PERSONAL FINANCIAL STATEMENT

U.S. SMALL BUSINESS ADMINISTRATION As of ,

Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.

Name Business Phone

Residence Address Residence Phone

City, State, & Zip Code

Business Name of Applicant/Borrower

ASSETS

Cash on hand & in Banks Savings Accounts IRA or Other Retirement Account Accounts & Notes Receivable Life Insurance-Cash Surrender Value Only

(Complete Section 8)

Stocks and Bonds (Describe in Section 3)

Real Estate (Describe in Section 4)

Automobile-Present Value Other Personal Property

(Describe in Section 5)

Other Assets (Describe in Section 5)

Total Section 1. Source of Income

Salary

Net Investment Income

Real Estate Income

Other Income (Describe below)*

Description of Other Income in Section 1.

(Omit Cents) LIABILITIES (Omit Cents)

$ Accounts Payable $ $ Notes Payable to Banks and Others $ $ (Describe in Section 2) $ Installment Account (Auto) $ $ Mo. Payments $

Installment Account (Other) $ $ Mo. Payments $

Loan on Life Insurance $ $ Mortgages on Real Estate $

(Describe in Section 4) $ Unpaid Taxes $ $ (Describe in Section 6)

Other Liabilities $ $ (Describe in Section 7)

Total Liabilities $

Net Worth $ $ Total $

Contingent Liabilities

$ As Endorser or Co-Maker $ $ Legal Claims & Judgments $ $ Provision for Federal Income Tax $ $ Other Special Debt $

*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.

(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)Section 2. Notes Payable to Banks and Others.

Original Current Payment Frequency How Secured or EndorsedName and Address of Noteholder(s) Balance Balance Amount (monthly,etc.) Type of Collateral

SBA Form 413 (3-00) Previous Editions Obsolete (tumble) This form was electronically produced by Elite Federal Forms, Inc.

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Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed).

Number of Shares Name of Securities Cost Market Value Date of Total ValueQuotation/Exchange Quotation/Exchange

Section 4. Real Estate Owned. (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed.)

Property A Property B Property C

Type of Property

Address

Date Purchased

Original Cost

Present Market Value

Name &Address of Mortgage Holder

Mortgage Account Number

Mortgage Balance

Amount of Payment per Month/Year

Status of Mortgage

(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms

Section 5. Other Personal Property and Other Assets. of payment and if delinquent, describe delinquency)

Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)

Section 7. Other Liabilities. (Describe in detail.)

Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)

I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001).

Signature: Date: Social Security Number:

Signature: Date: Social Security Number:

PLEASE NOTE: The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments concerning this estimate or any other aspect of this information, please contact Chief, Administrative Branch, U.S. Small Business Administration, Washington, D.C. 20416, and Clearance Officer, Paper Reduction Project (3245-0188), Office of Management and Budget, Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB.

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PERSONAL CASH FLOW STATEMENT

Name: ________________________________________________________________________

Name: ________________________________________________________________________

INCOME MONTHLY

Salary (Net after Taxes) ______________________

Spousal Salary (Net after Taxes) ______________________

Rental Income ______________________

Interest Income ______________________

Other __________________ ______________________

Other __________________ ______________________

TOTAL MONTHLY INCOME: ______________________

EXPENSES MONTHLY

Home Mortgage Payment (Including taxes & ins.) _______________________

Or Rent Expense _______________________

Other Real Estate Mortgage Payments _______________________

Auto Loan Payments _______________________

Other Loan Payments _______________________

Credit Card Payments (Minimum Due) _______________________

Utilities (electric, gas, oil) _______________________

Auto Insurance (please note if payment is annual) _______________________

Auto Fuel _______________________

Health Insurance (please note if payment is annual) _______________________

Life Insurance (please note if payment is annual) _______________________

Food _______________________

Phone (cell and land line) _______________________

Cable/Internet _______________________

Clothing _______________________

Child Care _______________________

Other Living Expenses _______________________

Other ____________ _______________________

TOTAL MONTHLY EXPENSES: ________________________

MONTHLY CASH FLOW SURPLUS (DEFICIT): ________________________

I/We hereby certify that the above information is valid and correct to the best of my/our knowledge.

Signature: ________________________________ Date: ___________________

Signature: ________________________________ Date: ___________________

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Storm Recovery Loan Program

75 Chestnut Street, Cranford, New Jersey 07016 T: 908.527.1166 F: 908.527.1207

www.ucedc.com

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