Ohio Department of Agriculture

Ohio Rural Development Partnership

8995 East Main Street

Reynoldsburg, OH  43068-3399

Phone:  (614) 995-1490

ruraldev@agri.ohio.gov

ORDP USE ONLY:

WEB FORM:  2201-001

REVISED:      04/20/2004

REQUEST FOR LOAN GUARANTEE APPLICATION

(This form is to be submitted by the lending institution.)

 

A.

Participating Lender Information:

 

 

Lender Name:

Phone:

 

 

 

Lender Address:

 

 

Lender's Federal Tax Identification Number:

 

 

(Tax ID number necessary to process loan application.)

B.

Borrower Information:

 

 

Borrower Name:

Phone:

 

 

 

Borrower Address:

 

 

 

C.

Purpose of Loan Guarantee Request:

 

 

 

 

 

 

 

 

 

D.

Project Data and Information:

 

1.

Briefly describe borrower's present or proposed agricultural operation.

 

 

 

 

 

 

 

2.

Date Business Established:  (Month/Year)

 

3.

Revenues in previous three years:

 

4.

Net profits in previous three years:

 

5.

Proposed location of assets to be financed:

 

Street:

 

City:

 

 

County:

 

Zip:

 

 

6.

 State Senator: District:
   

State Representative:

 District:

 

 

 

 

 

E.

Total Project Cost:

 

 

Lender Loan (full amount)

$

 

 

 

 

Equity:

$

 

 

 

 

Other (specify):

$

 

 

 

 

 

 

 

 

F.

Amount of State Guarantee Request:

$

 

 

 

 

 

%

 

of bank loan

G.

Summary of Project Costs:

 

Land

$

 

 

 

Buildings

$

 

 

 

New Construction

$

 

 

 

Renovation

$

 

 

 

Equipment

$

 

 

 

Other (explain)

$

 

 

 

Total Project Costs

$

 

 
         

H.

Working Capital (amount and source):

$

 

 
         

I.

Term of Loan:

#

 

Years
         

J.

Annual Interest Rate:

%

 

Unguaranteed Loan

 

 

%

 

Guaranteed Loan

 

 

%

 

Blended Rate
         

K.

Collateral:

Type

 

Value

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

L.

Certification and Statement of Borrower:

 

The Borrower named in this application has accurately and truthfully answered the questions as listed and has made application to the financial institution.  Said Borrower certifies, herein, that funds borrowed from the lending institution will be used for the purpose described in this application under the Family Farm Loan Program.

 

 

 

 

 

 

 

 

 

Date

 

Signature of Borrower

 

 

 

 

 

 

 

 

 

 

 

 

 

Type or Print Name of Borrower

 

 

M.

Certification of Financial Institution:

 

The financial institution making this application hereto certifies that the loan will be made to the Borrower under the terms described above.  The institution has reviewed the Family Farm Loan Program's "Guidelines and Procedures" and accepts the terms and conditions therein.  It is also understood that the decisions involved in making the loan to the borrower rests with the financial institution.

 

In consideration of the above, we have reviewed the credit worthiness of the above Borrower and the Program's guidelines, and based on our evaluation, we are willing to make the above-described loan if the State of Ohio provides the above-requested guarantee on the project.

Date

Financial Institution

Authorized Signature & Title

Type or Print Name of Borrower

 

PLEASE SEND COMPLETED APPLICATION TO:

Office of Financial Incentives

Ohio Department of Development

77 South High Street, 28th Floor

Columbus, OH  43216-6108