OMB Approval No.: 3245-0355

Effective Date: 11/07/2005 Expiration Date: 12/31/2006

**[ELIGIBILITY INFORMATION REQUIRED FOR]{.underline}**

**[GULF OPPORTUNITY PILOT LOAN PROGRAM SUBMISSION]{.underline}**

1.  Fill out all of this section. If a question in this section is
    answered "No," the loan is not eligible.

Applicant Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Lender Name
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Purpose of Loan
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Describe Type of Business
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Applicant is an operating business organized for profit, is located in
United States, has demonstrated a need for the

desired credit, and the desired credit is not otherwise available on
reasonable terms from non-Federal sources. YES\_\_\_NO\_\_\_

The products and/or services of the Applicant business are available to
the general public. YES\_\_\_NO\_\_\_

[Size and Affiliation]{.underline}

Primary industry of
Applicant\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_NAICS
Code of Applicant\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Average annual receipts of Applicant Business (excluding affiliates)
over last 3 completed fiscal
years\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

No. of employees of Applicant
Business\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ SBA size
standard for Applicant \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

[OR]{.underline} (alternative size standard) tangible net worth is
\_\_\_\_\_\_\_\_\_\_\_ (not in excess of \$7 million) and average net
income after Federal income taxes for the preceding two completed fiscal
years is \_\_\_\_\_\_\_\_\_\_\_ (not in excess of \$2.5 million).

If size standard is exceeded by no more than 25%, Applicant agrees to
use the assistance within a labor surplus area. YES\_\_\_NO\_\_\_

[CHECK IF APPLICABLE:]{.underline}

\_\_\_Applicant has possible affiliates. *If checked, provide the
following information in attachment to this form:*

List possible affiliates, discuss possible bases of affiliation and
determine if affiliation exists. If affiliation exists, state

1\) combined average annual receipts over last 3 completed fiscal years
or number of employees for applicant and all affiliates [or]{.underline}
2) combined tangible net worth and combined average net income for
applicant and all affiliates.

\_\_\_Applicant business is a franchise. *If checked, answer the
following question. If "No" loan is not eligible.*

Franchisee has the right to profit and risk of loss commensurate with
ownership and there are no excessive

restraints on the sale of the franchise interest. YES\_\_\_NO\_\_\_

[Principals of the Applicant]{.underline}

All principals of business are either U.S. citizens, or non-U.S.
citizens whose INS status has been verified by the

lender. YES\_\_\_\_NO\_\_\_

[CHOOSE ONE:]{.underline}

\_\_\_\_\_\_The business is at least 51 percent owned by individuals who
are U.S. citizens and/or who have verified Legal Permanent Resident
(LPR) status from INS and control the management and daily operations of
the business.

\_\_\_\_\_The business is at least 51 percent owned by aliens with a
verified status other than LPR, the lender has determined that continual
and consistent management of the business has been provided by a U.S.
citizen or by a verified LPR for at least one year and will continue
indefinitely AND U.S. collateral is pledged sufficient to pay the loan
in full at any time. (Businesses less than one year old do not meet
these requirements.)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

No Associate of the Applicant is incarcerated, on probation, on parole,
or under indictment for a felony

or a crime of moral turpitude. YES\_\_\_NO\_\_\_

# Terms of the Loan

The maturity of the loan does not exceed the maximum allowable by SBA
and is the shortest appropriate term

commensurate with repayment ability of the Applicant. If the loan is
revolving, the maturity does not

exceed seven years. YES\_\_\_NO\_\_\_

SBA guaranty percentage on this loan does not exceed 85%. .
YES\_\_\_NO\_\_\_

The aggregate amount of the SBA portions for this application and all
outstanding loans to Applicant and its

affiliates does not exceed \$1,500,000. YES\_\_\_NO\_\_\_

The interest rate of the loan does not exceed 6.5% over prime rate for
loans of \$50,000 and less or 4.5%

over prime rate for loans over \$50,000. YES\_\_\_NO\_\_\_

Applicant does not have a non-SBA-guaranteed loan made by any lender at
or about the same time for the same or

similar purpose as this loan, with a lien position senior to this loan
("Piggyback Loan structure"). YES\_\_\_NO\_\_\_

II. CHECK ANY ITEMS THAT ARE APPLICABLE IN THIS SECTION.

# Type of Business

\_\_\_Applicant is or does one of the following. *If checked, loan is
not eligible.*

-   primarily engaged in the business of lending

-   a passive business that holds real and/or personal property to
    receive rent or lease income and does not provide sufficient
    services to deem it active and is not an Eligible Passive Company
    discussed below

-   life insurance company

-   pyramid sale distribution plan

-   any illegal activity

-   consumer or marketing cooperative

-   earns 1/3 or more of its gross annual revenue from packaging SBA
    loans

-   primarily engaged in political or lobbying activities

-   a speculative business (such as oil wildcatting)

\_\_\_Applicant is a pawn shop. *If checked, answer the following
question. If "No" loan is not eligible.*

More than 50% of Applicant's income for the previous year was from the
sale of merchandise

rather than from interest on loans. YES\_\_\_NO\_\_\_

\_\_\_Applicant is a motel, trailer park, campground or similar type of
business. *If checked, answer*

*the following question. If "No" loan is not eligible.*

Applicant derives 50% or more of its gross annual income from transients
who stay for periods of

time not exceeding 30 days. YES\_\_\_NO\_\_\_

\_\_\_Any of gross annual revenue of Applicant business is derived from
gambling. *If checked, answer the*

*following question. If "No" loan is not eligible.*

The revenue is from legal gambling activities and comprises 1/3 or less
of gross annual revenue of

Applicant business and the business is not a racetrack, casino or
otherwise have gambling as its

reason for being. YES\_\_\_NO\_\_\_

\_\_\_Applicant is a private club or business. *If checked, answer the
following question. If "No" loan is not*

*eligible.*

Business does not limit the number of memberships for reasons other than
capacity. YES\_\_\_NO\_\_\_

\_\_\_Applicant is a government-owned entity. *If checked, answer the
following question. If "No" loan*

*is not eligible.*

Applicant is business owned or controlled by a Native American tribe,
but is a separate legal

entity from the tribe. YES\_\_\_NO\_\_\_

\_\_\_Applicant is an Eligible Passive Company (EPC). *If checked, fill
in the blanks and answer the*

*following questions. If "No" loan is not eligible. Attach additional
sheet with Names and Legal Forms*

*if more than one OC. References below to OC mean [each]{.underline}
OC.*

Name of Operating Company
(OC)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Legal Form of Entity of
OC\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   The EPC will use the loan proceeds to acquire or lease, and /or
    improve or renovate real or personal

> property (including eligible refinancing) that it leases 100% to one
> or more OCs. YES\_\_\_NO\_\_\_

-   The OC is an eligible small business and the proposed use of
    proceeds would be an eligible use if

> the OC were obtaining the financing directly. YES\_\_\_NO\_\_\_

-   The EPC (with the exception of a trust) and the OC each are small
    under SBA's size standards. YES\_\_\_NO\_\_\_

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-   The EPC is eligible as to type of business, other than being
    passive. YES\_\_\_NO\_\_\_

-   The lease between the Eligible Passive Company and the Operating
    Company will be in writing,

> will have a remaining term at least equal to the term of the loan
> (including options to renew exercisable
>
> solely by the Operating Company), will be subordinated to SBA's lien
> on the property and the rents
>
> will be assigned as collateral for the loan. YES\_\_\_NO\_\_\_

-   The OC will be a guarantor or co-borrower. If loan proceeds include
    working capital or assets

> to be owned by the OC, it will be a co-borrower. YES\_\_\_NO\_\_\_

-   Each 20% or more owner of the EPC and each 20% or more owner of the
    OC will guarantee

> the loan. YES\_\_\_NO\_\_\_

-   The aggregate amount of the SBA portions for this application and
    for all outstanding loans to

> the EPC, the OC, and their affiliates does not exceed \$1,500,000.
> YES\_\_\_NO\_\_\_

-   Neither the EPC nor the OC is a trust or SBA requirements regarding
    trusts are met. YES\_\_\_NO\_\_\_

# Use of Proceeds

\_\_\_To provide or refinance funds used for payments, distributions, or
loan to Associates of the Applicant,

except payment of ordinary compensation for services rendered. *If
checked, loan is not eligible.*

\_\_\_For debt refinancing. *If checked, ATTACH A DEBT SCHEDULE SHOWING
THE TERMS OF THE DEBT TO*

*BE REFINANCED AND THE JUSTIFICATION FOR THE REFINANCING. Also, answer
the following*

*questions. If "No" loan is not eligible.*

-   Existing debt no longer meets the needs of the Applicant.
    YES\_\_\_NO\_\_\_

-   Loan will not reduce the lender's exposure with the Borrower.
    YES\_\_\_NO\_\_\_

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-   Proceeds will not pay a creditor in a position to sustain a loss
    causing a shift to SBA of all or

> part of a potential loss from an existing debt. YES\_\_\_NO\_\_\_

-   Debt to be refinanced is not an SBA loan. YES\_\_\_NO\_\_\_

-   Loan will not refund debt to an SBIC. YES\_\_\_NO\_\_\_

-   Loan will not repay third party financing for any existing 504
    project. YES\_\_\_NO\_\_\_

-   Loan will not repay delinquent IRS withholding taxes, sales taxes or
    similar funds held in trust. YES\_\_\_NO\_\_\_

\_\_\_For a purpose that will not benefit the small business. *If
checked, loan is not eligible.*

\_\_\_To fund or refinance a change in ownership. *If checked, answer
the following questions. If "No" loan*

*is not eligible.*

-   The change will promote the sound development or preserve the
    existence of the Applicant business. YES\_\_\_NO\_\_\_

-   The change is an arm's-length transaction supported by a
    determination of value. The loan file is

> well documented regarding the valuation and includes the
> substantiating analysis. If the valuation
>
> analysis is performed by the lender's loan officer, [a synopsis of the
> analysis is attached.]{.underline} If buyer and
>
> seller are related, transaction is supported by independent third
> party valuation. YES\_\_\_NO\_\_\_

-   Change is 100% of ownership or a business repurchasing 100% of one
    or more of its owners'

> interests. YES\_\_\_NO\_\_\_

-   If the loan is paying off an SBA guaranteed loan of the seller, the
    loan being paid off is not

> with the same lender submitting this loan request. YES\_\_\_NO\_\_\_

\_\_\_For construction or refinance of construction of a new building.
*If checked, answer the following*

*questions. If "No" loan is not eligible.*

-   If building will contain rental space, Applicant (or Operating
    Companies) will continue to occupy

> at least 60% of the rentable property for the term of the loan; lease
> long term no more than 20% of the
>
> rentable property to one or more tenants; plans to occupy within three
> years some of the remaining
>
> rentable property not immediately occupied or leased long term; and
> plans to occupy within ten years
>
> all of the rentable property not leased long term. YES\_\_\_NO\_\_\_

-   Community improvements do not exceed 5 percent of construction
    proceeds of this loan. YES\_\_\_NO\_\_\_

\_\_\_To provide funds for or refinance of acquisition of land or
existing building or for renovation or reconstruction

of an existing building. *If checked, answer the following questions. If
"No" loan is not eligible.*

-   Applicant (or Operating Companies) will occupy at least 51% of the
    rentable property. YES\_\_\_NO\_\_\_

-   Loan proceeds will not be used to remodel or convert any rental
    space in the property. YES\_\_\_NO\_\_\_

\_\_\_To provide funds for or refinance of leasehold improvements. *If
checked, answer the following question.*

*If "No" loan is not eligible.*

Loan proceeds will be used to improve space occupied 100% by Applicant.
YES\_\_\_NO\_\_\_

\_\_\_To provide funds to guarantee or fund a letter of credit. *If
checked, loan is not eligible.*

# 

# Conflict of Interest

\_\_\_Associate or member of Associate's household is GS-13 or higher
government employee, Major or Lieutenant

Commander or higher in military. *If checked, answer the following
question. If "No" loan is not eligible.*

Applicant has submitted statement of no objection by pertinent
department or military service. YES\_\_\_NO\_\_\_

\_\_\_A community organization (except state and local development
companies) or its officers or its directors have

a significant financial interest in the Applicant unless the
organization has been inactive in packaging SBA loans

for at least two years prior to the application date. (*Loan is not
eligible for this process.)*

\_\_\_Employee (or member of employee's household) of a community
organization such as a certified development

company or microlender has a significant financial interest in the
Applicant. (*Loan is not eligible for this process.)*

\_\_\_SBA employee, close relative or member of employee's household, or
former SBA employee separated from SBA

less than one year has a financial interest in the Applicant. (*Loan is
not eligible for this process.)*

\_\_\_Individuals currently involved in the Small Business Institute or
Small Business Development Company Programs

or members of their household have a significant financial interest in
the Applicant. (*Loan is not eligible for this process.)*

\_\_\_A member of Congress or member of his/her household is an officer,
director or shareholder with 10 percent or more

interest in the Applicant. (*Loan is not eligible for this process.)*

\_\_\_Appointed official or employee of the federal legislative or
judicial branch, a member or employee of a Small Business

Advisory Council, a SCORE or ACE volunteer, or a close relative, is a
sole proprietor, partner, officer, director, or

shareholder with 20 percent or more interest in the Applicant. (*Loan is
not eligible for this process.)*

**[Ethical Requirements (*If any of these items are checked, loan is not
eligible for this process.)*]{.underline}**

\_\_\_Lender or Associate of Lender has a real or apparent conflict of
interest with Applicant, any of Applicant's

Associates, or any of the close relatives of Applicant's Associates.

\_\_\_Lender or any Associate of Lender owns or owned within 6 months
prior to this application an equity interest

in Applicant.

\_\_\_Lender or any Associate of Lender is incarcerated, on parole, or
on probation or is a convicted felon or has an

adverse final civil judgment that would cause the public to question the
Lender's business integrity.

\_\_\_Lender or any Associate of Lender has accepted funding from a
source that restricts, prioritizes, or conditions the

types of small businesses that Lender may assist under an SBA program or
that imposes any conditions or

requirements upon recipients of SBA assistance inconsistent with SBA's
loan programs or regulations.

\_\_\_Loan proceeds will directly or indirectly finance purchase of real
estate, personal property or services from

Lender or an Associate of Lender.

\_\_\_Applicant, an Associate of Applicant, or close relative of
Associate of Applicant is required to invest in Lender.

\_\_\_Proceeds will be used to acquire space in project for which lender
has issued a real estate forward commitment.

**[Special Program Requirements]{.underline}**

\_\_\_ Business applicant is located in, locating to, or relocating in
the counties/parishes that have been Presidentially-declared disaster
areas resulting from Hurricanes Katrina or Rita, plus any
parishes/counties contiguous to those parishes/counties. (A complete
list of all eligible parishes/counties (Presidentially-declared and
contiguous) is located at
[www.sba.gov/financing](http://www.sba.gov/financing) .) Additionally,
the loan proceeds will be used to support the business's operations
within the eligible parish/county.

Business address where the business is located or will be located:

(street number and
name)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(county/parish)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(state)\_\_\_\_\_\_\_\_

*If "No" loan is not eligible for this program.* YES\_\_\_NO\_\_\_

\_\_\_Loan is one of the following special purpose loans *(Loan is not
eligible for this program):*

-   Disabled Assistance Loan Program (DAL)

-   Energy Conservation

-   International Trade Loans or SBA Export *Express* loans

-   Qualified Employee Trusts (ESOP)

-   Pollution Control Program

-   Defense Loan and Technical Assistance (DELTA)

-   CapLines Program (including Builders Loan Program)

-   Community Adjustment and Investment Program (CAIP)

\_\_\_Applicant is or does one of the following *(Loan is not eligible
for this program.):*

-   Agricultural or farm business

-   Fishing or shore operation (including commercial fishing activities
    and the construction of new fishing vessels)

-   Medical facility involving any type of extended care/assisted living
    situation

-   Mine (including sand and gravel pits)

-   Has operations, facilities, or offices located overseas (other than
    those strictly associated with the marketing and/or distribution of
    products exported from the U.S.)

-   Is engaged in teaching, instructing, counseling or indoctrinating
    religion or religious beliefs, whether in a religious or secular
    setting

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-   Derives directly or indirectly more than de minimis gross revenue
    through the sale of products or services, or the presentation of any
    depiction or displays, of a prurient sexual nature or that presents
    any live performances of a prurient nature.

\_\_\_Applicant has existing SBA loans(s). *If checked, answer the
following question. If "No" loan is not eligible.*

The existing SBA loan(s) is/are current. YES\_\_\_NO\_\_\_

\_\_\_Loan finances more than 90% of 1) the actual cost of real estate
being acquired; 2) the financing needs for a

new business; or 3) the acquisition of an existing business. *(Loan is
not eligible for this program..)*

\_\_\_Question 1, 2, or 3 on SBA Form 2281, Gulf Opportunity Pilot Loan
Program Borrower Information Form, for this

application is answered "Yes." *(Loan is not eligible for this
program.)*

\_\_\_ Lender is aware that the application was previously submitted to
SBA under any SBA program (except disaster), including SBA*Express*,
Community*Express*, PLP, CLP, LowDoc, or regular 7(a). *(Loan is not
eligible for this program.)*

\_\_\_Loan will have primary collateral that will not meet SBA's
environmental requirements or that will require

use of a non-standard indemnification agreement. *(Loan is not eligible
for this program.)*

\_\_\_Business previously defaulted on a Federal loan or Federally
assisted financing that resulted in the Federal government

or any of its departments or agencies sustaining a loss; or a business
owned or controlled by a principal or any

Associates which previously owned or operated a business which defaulted
on a Federal loan (or guaranteed a

loan which was defaulted) and caused the Federal Government or any of
its agencies or departments to sustain

a loss in any of its programs, including any compromise agreement with
any such agency/department; or a

principal was the recipient of a student loan that is in delinquent
status. *(Loan is not eligible for this program.)*

ATTACH SHEET FOR COMMENTS REGARDING ANY OF ABOVE ANSWERS THAT REQUIRE
EXPLANATION OR REGARDING ANY OTHER RELEVANT ELIGIBILITY ISSUES.

Is additional information attached? YES\_\_\_NO\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Lender hereby certifies that the above information is true and correct,
to the best of its knowledge, and that it has exercised due diligence to
obtain the true and correct information. Lender is aware and
acknowledges that SBA review of this form is a quick look at eligibility
intended to provide limited protection to SBA and the lender from making
an ineligible loan on which SBA could not honor its guarantee and that
if an SBA loan number is assigned and SBA later learns that the loan is
not eligible, SBA still may deny liability on its guarantee.

Signature of authorized lender
representative\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date\_\_\_\_\_\_\_\_\_\_\_\_\_

Printed Name and Title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

The estimated burden for completing this form is 15 minutes. You will
not be required to respond to any collection of information unless it
displays a currently valid OMB Control Number. Comments on the burden
should be sent to U. S. Small Business Administration (SBA), Chief, AIB,
409 3rd Street, SW, Washington, DC 20416 and Desk Officer for SBA,
Office of Management and Budget, New Executive Office Building, Rom
10202, Washington, DC 20503. OMB Control Number 3245-0355. PLEASE DO NOT
SEND FORMS TO OMB.