GUARANTEE ASSET PROGRAM ("GAP") APPLICATION
|
Name of Bank: |
____________________________________________________ |
|
Contact Person: |
____________________________________________________ |
|
Street or PO Box: |
____________________________________________________ |
|
City, State, Zip: |
____________________________________________________ |
|
Phone: |
____________________________________________________ |
Borrower Information
|
Name of Borrower: |
____________________________________________________ |
|
Contact Person: |
____________________________________________________ |
|
Street or PO Box: |
____________________________________________________ |
|
City, State, Zip: |
____________________________________________________ |
|
Phone: |
____________________________________________________ |
Information about the Transaction
|
a. Total Loan Amount: |
________________________________________________ |
|
b. % of Gty. Requested: |
________________________________________________ |
|
c. (a)*(b): |
________________________________________________ |
|
d. % of Loan for Working Capital: |
________________________________________________ |
|
e. Amount of Existing Debt: |
________________________________________________ |
|
f. Appraisal Amount and Date: |
________________________________________________ |
Job Impact Information - Please answer in Full-Time Equivalents
a. Existing number of Employees in New Hampshire: ____________________________
b. Number of Jobs Maintained as a Result of Loan: ____________________________
c. Number of Jobs Created as a Result of Loan: _______________________________
Guarantors
Please provide contact information on the guarantors, if any.
|
Name: |
____________________________________________________ |
|
Street or PO Box: |
____________________________________________________ |
|
City, State, Zip: |
____________________________________________________ |
|
Phone: |
____________________________________________________ |
Summary
Please briefly summarize the purpose of this transaction:
_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
_______________________________________________________________________
________________________ ________________________
Date Signature of Applicant