Loan Request - Individual SAGE Student

Business Information: Business Name:

______

Date Started:

______Individual Owner(s) Name: ______Individual Owner(s) Address: ______

______

______Individual Owner(s) Phone Numbers ______Individual Owner(s) E- mail Address ______How Much Money (in U.S. Dollars) Are You Requesting? ______(Maximum: $100 for Individuals) Purpose of the Loan: ______How Would You Like to Pay the Loan Back After One Year from the Date the Loan Proceeds are Received?

___ In one lump payment, plus 5% interest ___ In four equal payments, payable at the end of each of the next four quarters after Year 1, using a 5% annual interest rate ___ In 12 equal payments, payable at each of each of the next twelve months after Year 1, using a 5% annual interest rate Business Plan

In a separate attachment, please answer the following questions (if you have a formal business plan, include your plan, but make sure each of the following questions is addressed):

1. Please provide a brief history of your business, future plans and projections, and

describe your products and/or services and competition.

2. Please describe your previous business experience. (Include business

background, management experience, and training, or include a resume.)

3. What is your business’s competitive advantage? What makes it different?

4. At what price will you sell?

5. Where will you be selling your goods or services?

6. How will you advertise your business?

7. Are there any environmental concerns about your business?

8. Please include a projected balance sheet at the end of the first year; also include a

projected income statement for your business for the first year.

9. Include a personal list of assets and liabilities (e.g., a personal balance sheet). BUSINESS INFORMATION Business Name Address Telephone ( ) Individual Name(s) Address Telephone ( ) Date of Birth: Proprietorship ______Partnership ______Sub-Chapter S______Corporation ______Non-Profit ______Individual ______LLC ______

Ownership Distribution: (List partners, owner names) Note: Attach separate sheet if additional space needed.

Name Title # of Months % Name Title # of Months % Name Title # of Months %

Nature of Business Date Established Number of Employees Months at Present Location [ ] Own [ ] Lease

FINANCIAL INFORMATION Bank of Account (if any) Account Number

Credit Relationships: Please provide details of your business credit relationships below:

Original Loan Amount Maturity Name of Creditor Purpose of Loan Amount Presently Owing Repayment Date Terms $ $ $ $ $ $ LOAN REQUEST Amount of Loan Requested (in U.S. Dollars) Type of loan

[ ] One year simple interest loan, with principal and interest payable at 5% at the end of loan contract $ ______is signed [ ] One year installment loan, with principal and interest payable at an annual interest rate of 5% in four quarterly installments starting one year after the loan contract is signed [ ] One year installment loan, with principal and interest payable at an annual interest rate of 5% in 12 monthly installments starting one year after the loan contract is signed [ ] Other (to be negotiated)

Specific Loan Purpose (Check all that apply)

[ ] Working Capital [ ] Other (State type of loan required and loan [ ] Finance Purchase of Inventory purpose) [ ] Finance Purchase of Equipment ______[ ] Finance Purchase of Real Estate ______[ ] Finance Purchase of Business ______[ ] Refinance Existing Loan or Debts ______

CERTIFICATION The undersigned certifies that, to the best of his or her knowledge and belief, all information contained in this loan application and in the accompanying statements and documents is true, complete, and correct. The undersigned agrees to notify the SAGE Bank immediately of any material changes in this information

Business Name (print): Applicant Signature(s): Date:

Applicant Title:

SAGE Teacher or Date: Advisor (s) Signature: SAGE Country Date: Coordinator Signature:

The SAGE Country Coordinator will submit the application to SAGE Headquarters for loan processing. If approved, we will forward a promissory note for you to sign. After this note is received by SAGE Headquarters, you will receive your loan proceeds within two weeks.