The RLF Form for Reporting Loans Disbursed/Requesting a Release of Grant Funds
(Not for submission)
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:
Total Project ____________
Number of Jobs created and/or saved:*
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:
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
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:
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.
The documents checked below will be obtained from the borrower and will be available for examination by ARC staff after loan closing.
- The borrower's loan application. _______
- Standardized borrower financial Statements. _______
- Grantee's loan commitment letter. _______
- Other relevant information relating to the application.
Specify documents: (Indicate "none" if there are none) _______
- Collateral/Security documents (check appropriate item) _______
Loan Use Agreement _______
Promissory Note _______
Security Agreement _______
Personal Guarantee(s) _______
Key Person Life Insurance _______
Borrower's Hazard Insurance _______
Other (Specify) _______
- A credit report or credit verification on borrower. _______
- 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. _______
- A copy of the loan review committee minutes or certified resolution recommending approval of the loan. _______
- A copy of Board of Directors minutes or certified resolution approving the loan, if applicable. (N/A_____) _______
- 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:
- A copy of the Loan Review Committee recommendation on the loan application.
- A copy of Board of Directors minutes or certified resolution approving the loan.
- 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