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The RLF Form for Reporting Loans Disbursed/Requesting a Release of Grant Funds

(Not for submission)

Borrower's name:

Borrower's business mailing address:

Location of business: (street address/location, city, county)

Type of business:

Amount of the ARC loan:

Describe the project in which the loan is to be used:

Funds will be used for:




New Construction

Alteration/Renovation Machinery:

New Purchase



New Purchase


Working capital


(Specifically State)

Total Project ____________

Number of Jobs created and/or saved:*
S: ____________

Number of months, from loan closing that the borrower has to create jobs:* *(In the case of Private Developers, see instruction 8, Appendix A.) ____________

Terms of the ARC Loan:

Interest rate: ______________

Length of loan: Years:_______ Months:________ Conditions (if any):

Sources of Funds:

Borrower's Equity

Commercial Bank Loan



State Loan Program

SBA (Small Business Administration Loan)

RBCS (Rural Business Cooperative Service) IRP

CDBG (Community Development Block Grant Loans)

Local Loan Program

Additional Sources:

(Specifically State)

Total of Funding Sources _______

Type of Collateral/Security provided:

Mortgage Position: 1st______2nd______3rd______

Identify Property Secured:

Chattel Mortgage/Lien: 1st______2nd______3rd______

Identify Collateral Pledged:

Personal Guarantee(s) by:

Key Person Life Insurance on:

Other: (Specify)

This Loan satisfies the (grantee name)________________________RLF Operating Plan.

________ Goals & Objectives ___________ Targeting Requirements

The borrower has met the established eligibility criteria.

____ Yes ____ No ______ Exception to eligibility criteria.

Explain exceptions:

The documents checked below will be obtained from the borrower and will be available for examination by ARC staff after loan closing.

  1. The borrower's loan application. _______

  3. Standardized borrower financial Statements. _______

  5. Grantee's loan commitment letter. _______

  7. Other relevant information relating to the application.

    Specify documents: (Indicate "none" if there are none) _______


  9. Collateral/Security documents (check appropriate item) _______
  10. Mortgage _______

    Loan Use Agreement _______

    Promissory Note _______

    Lien _______

    Security Agreement _______

    Note _______

    Personal Guarantee(s) _______

    Key Person Life Insurance _______

    Borrower's Hazard Insurance _______

    Other (Specify) _______


  11. A credit report or credit verification on borrower. _______

  13. Written evidence that commercial lending for the borrower was not otherwise available on the terms and conditions which would permit completion, successful operation or accomplishment of the borrower's project. _______

  15. A copy of the loan review committee minutes or certified resolution recommending approval of the loan. _______

  17. A copy of Board of Directors minutes or certified resolution approving the loan, if applicable. (N/A_____) _______

  19. A copy of State approval/concurrence, if required. (N/A_____) _______

I certify that there is no actual or potential conflict of interest for any officer or employee of (name grantee)_____________________________________, any current or former member of the grantee's Loan Review Committee, Board or Directors or staff who reviews, approves or otherwise participates in decisions on RLF loans or people related to them by blood, marriage or law.

I certify that to the best of my knowledge and belief the information provided on this form is correct and complete.

RLF Manager (or other responsible official designated by the grantee)


Required Attachments to this Form:


  1. A copy of the Loan Review Committee recommendation on the loan application.
  2. A copy of Board of Directors minutes or certified resolution approving the loan.
  3. Evidence of State approval/concurrence in the loan if required by the State.


ARC Business Development RLF Guidelines | Appendix A | Appendix B | Table B-1 | Schedule B-1 | Schedule B-2 | Schedule B-3 | Appendix C | RLF Form in PDF format