Small Business Economic Development (SBED) Loan is sponsored by State of Alaska. The Small Business Economic Development Loan is a revolving loan program from the State of Alaska Division of Investments that provides financing of up to 300,000 dollars to support the startup and expansion of small businesses that create long-term employment in Alaska.

Th e Division of Investments, Department of Commerce, Community, and Economic Development complies with Title II of the Americans with Disabilities Act of 1990. This publication is available in alternative communication formats upon request. Please contact the Division of Investments at (907) 465-2510 or TDD (907) 465-5437 to make any necessary arrangements.

Mail Applications To: By Telephone: By Email: DCCED P. O. Box 110802 Juneau, AK 99811-0802 (800) 478-LOAN (5626) Toll Free within Alaska (907) 465-5437 TTD In Person: Juneau Office Anchorage Office State Office Building Robert B.

Atwood Building 333 Willoughby Ave. 9th Floor 550 W. 7th Ave.

, Suite 1850 Juneau, Alaska (907) 465-2510 Office (907) 465-2103 Fax Anchorage, Alaska Website: www. commerce. alaska.

gov/web/ inv DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund # Small Business Economic Development Revolving Loan Fund AS 44. 88. 400 – AS 44.

88. 430 3AAC 99. 800 – 3AAC 99.

820 To provide private sector employment by financing the start-up and expansion of businesses that will create significant long-term employment. ## Contact Information DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund ##  Companies must be a small business as defined by the Small Business Administration (SBA).

The SBA definition includes thresholds for number of employees, net worth and annual net income. Generally, a business must have fewer than 500 employees, have a net worth under $6 million and have an average net income after Federal taxes for the preceding two years less than $2 million to ##  Loans may be made for working capital, equipment, or other commercial purposes.

##  Loans may not be made to pay costs that were incurred more than 12 months before receipt of the loan application to the Division of Investments. ##  Applicants may be required to supply a turn down letter from a lender listing the reason(s) for denial.

If a bank is willing to finance a portion of the project, applicants may be required to supply a letter from the bank explaining the reasons the bank is unable to finance the entire project. ##  Loans may not be made to applicants that have been debarred or suspended from receiving federal benefits.

##  Loans must result in the creation or retention of jobs that would be lost in eligible Eligibility for the SBED program includes all communities in the state of Alaska with a population of less than 30,000. Loans in communities of 30,000 or more are available on a limited basis, depending on funds availability. To check on funds availability, please contact the Juneau office.

> “Eligible areas include the land granted to Native Alaskans that remains in the ownership of the Village Corporations, the twelve Alaskan Regional Corporations and the traditional Alaskan Native Villages. > These terms are defined under the Alaska Native Claims Settlement Act, as amended, and 13 CFR 301. 2.

” # GENERAL REQUIREMENTS  Funding is limited. Applicants are encouraged to call and discuss availability of funds prior to submitting a loan application. ##  Maximum loan amount is generally $75 0,000.

##  Interest rate is fixed at the time of approval; generally below 6% (contact us for ##  Maximum term is generally 20 years for fixed asset loans and generally 5 years for working capital loans. ##  All loans must be adequately secured. The loan amount may not exceed 90% of the value of the collateral offered.

##  A reasonable amount of money from other sources must be committed for use on any project funded through SBED and generally will not be less than 10%. ##  Loans may be in a subordinate position to associated private sector loans.

##  All assets purchased with loan proceeds must be offered as collateral for the ##  Personal guarantees are required of all persons holding 20% or more ownership interest in the business receiving the loan. ##  Payment frequency can be monthly, quarterly, semi-annual or annual. ##  A $250 application fee must accompany all applications.

This fee will be credited toward the origination fee due if the application is approved. ##  A 1% origination fee ($100 minimum) is due at the time that the loan is closed. ##  Applicants will be responsible for all closing costs.

DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund # FUNDING 1.

Comply with Title VI of the Civil Rights Act of 1964 whereby no person in the United States shall be on the basis of race, color, or national origin be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the program by which the Borrower receives federal financial assistance and will immediately take any measures necessary to effectuate this agreement. 2.

Comply with Title VI of the Civil Rights Act of 1964 (42 USC 2000d) prohibiting employment discrimination where: A. The primary purpose of the financial assistance is to provide employment; or B. discriminatory employment practices will result in unequal treatment of persons who are or should be benefiting from the loan-aided activities.

3. Comply with Section 112 of Public Law 92-65 and Title III of Public Law 94-135 whereby the Borrower assures that no person in the United States shall be, on the basis of sex or of age, discriminated against in connection with loan-aided activities. 4.

Comply with Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), and the implementing regulations of the Department of Commerce, Community and Economic Development in 15 CFR 8b, prohibiting discrimination against and providing fair and equitable treatment of the handicapped under programs or activities receiving federal financial assistance; and such other civil rights legislation as is applicable. 5.

Comply with the flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973, Public Law 93-284, 87 Stat. 975, approved December 31, 1976.

Section 102(a) requires, on and after March 2, 1975, the purchase of flood insurance in communities where such insurance is available as a condition for the receipt of any federal assistance for construction or acquisition purposes for use in any area that has been identified by the Secretary of the Department of Housing and Urban Development as an area having special flood hazards.

The phrase “federal financial assistance” includes any form of loan, grant, guaranty, insurance payment, rebate, subsidy, disaster assistance loan or grant, or any other form of direct or indirect federal assistance. Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund The following federal requirements apply to all loans made under this program.

A violation of any of these requirements will be cause for default on the loan. All projects and borrowers must: DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund 6.

Comply through the Lender with Section 106 of the National Historic Preservation Act of 1966 as amended (16 USC 470), Executive Order 11593, and the Archeological and Historic Preservation Act of 1966 (16 USC 469a-1 et seq.) By: A.

Consulting with the State’s Historic Preservation Officer on the conduct investigation, as necessary to identify properties listed in or eligible for inclusion in the National Register of Historic Places that are subject to adverse effects (see 36 CFR Part 800. 8) by activity, and notifying the Lender of the existence of any such properties; and by B. Complying with all requirements by the Lender to avoid or mitigate adverse effects.

7. Comply with Section 2 of the Public Works and Economic Development Act which states that under the provisions of this Act new employment opportunities should be created by developing and expanding new and existing facilities and resources than by merely transferring jobs from one labor area to another. 8.

Assure that the business financed is not/will not be moved outside of the project area, also that the loan funds are not used for relocating jobs from another commuting area. 9.

Assure that any building or facility financed in whole or in part by any funds provided under the program will be designed, constructed or altered so as to assure ready access to and use of such building or facility by the physically handicapped, pursuant to Public Law 90-480, as amended (42U. S. C.

4151, et seq), and the regulations issued there under. This provision applies only to firms which deal directly with the general public in the normal and usual course of their business, and to facilities in which business is customarily transacted by and with members of the general public. 10.

Ensure that the facilities under its ownership, lease or supervision which shall be utilized in the accomplishment of the project are not listed on the Environmental Protection Agency’s (EPA) list of Violating Facilities and that it will notify Lender of the receipt of any communication from the Director of the EPA Office of Federal Activities indicating that a facility to be used in the project is under consideration for listing by the EPA.

11. Comply with all requirements imposed by the federal sponsoring agency concerning special requirements of law, program requirements, and other administrative requirements. 12.

Comply with the Davis Bacon Act, as amended (40 USC 276a-276a-5). DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund 13. Comply with the Contract Work hours and Safety Standards Act, as amended (40 U.S.C.

327-333) and with the Anti-Kickback Acts, as amended (40 U.S.C. 276 9c); 18 U.S.C. 874).

14. Comply with: A. The Clean Air Act, as amended (42 U.S.C.

7401 et. seq.) ; B.

The Federal Water Pollution Control Act, as amended (33 U.S.C. 1251, et. seq); C.

The Coastal Zone Management Act of 1972, P. L. 92-583, as amended (16 U.S.C.

1451, et seq); D. Executive Order 11988, Floodplain Management (May 24, 1977), and regulations and guidelines issued by the Economic Development Administration; E. Executive Order 11990, protection of Wetlands (May 24, 1977); F.

The Endangered Species Act of 1973 P. O. 93-205, as amended (16 U.S.C.

1531, et seq.) ; G. The Safe Drinking Water Act, P.

O. 93-523, as amended (42 U.S.C. 300f-300j-9); H.

The Wild and Scenic Rivers Act, as amended (16 U.S.C. 1271, et seq.) ; I.

The Resource Conservation and Recovery Act of 1976, P. L. 94-580, as amended (42 U.S.C.

6901); J. The Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA), P. O.

96-510, as amended by Superfund Amendments and Reauthorization Act of 1986 (SARA) (42 U.S.C. 6091, et seq.) [As deemed necessary, the Recipient shall require compliance with EDA policy and procedures regarding the identification of hazardous and toxic waste on real property affected by RLF activities in accordance with EDA Directive 17.

01, promulgated to reduce liabilities for environmental cleanup under CERCLA and SARA. This will require a certification to demonstrate a “due diligence” examination of project site(s) and for any environmental contamination that may affect real property for which EDA might be placed in the chain of title, or that is affected by EDA assisted construction activities.] ; and K.

Coastal Barriers Resources Act P. O. 97-348 (16 U.S.C.

3501, et seq.) DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund The following information is required in order to process your application. Please use the list to make sure all information is submitted.

Retain a copy of this application for your records. The department may require additional information or documentation as it deems necessary in order to verify eligibility or other requirements of the program . Application for Small Business Economic Development Loan: Be sure the form has been completed and signed.

If a partnership or corporation, each individual owning 20% or more must submit an application (Page 1). 2 Non-refundable Application Fee: You must include a check or money order for $250. 3 Letter of Intent: (Page 2) 4 Environmental Impact Assessments: (Pages 3 & 4 ) 5 Project Funding Summary: (Page 5) 6 Business Profile: (Page 6) Individual Financial Statement: Required from all individual applicants.

If the applicant is a corporation, required from all individuals owning 20% or more of any outstanding shares. If applicant is a partnership or other association, required from all individuals in the organization. Must indicate financial condition of the individual as of no more than 90 days prior to receipt of application (Pages 7 & 8 ).

8 Business Financial Statement: Must indicate financial condition of business as of no more than 90 days prior to receipt of application (Pages 9 & 10 ). 9 Collateral: (Page 11 ). 10 Actual Statement of Profit & Loss: (Page 1 2).

11 Projected Statement of Profit & Loss: (Pages 13 & 14 ). 12 Copy of government issued identification: Provide a copy of each applicant’s valid government issued identification at or before loan closing. 13 Authorization to Obtain Credit and/or Release Information: (Page 15 ).

Federal Tax Returns: Include complete, signed copies of your federal income tax returns for the last three years. You must also submit the business’ last three year’s tax returns. Corporations must submit complete copies of their last three year’s federal income tax returns, as well as returns for individuals owning 20% or more of the corporation.

16 Original Earnest Money Agreement, Contractor’s Bid, Purchase Agreement, or Other documentation to verify the use of the loan proceeds. Turndown Letters: If required, a ttach: a) turndown letters from other lenders, listing the terms and reasons for denial; or b) a list of lenders that were contacted, the amount of financing requested and the reason for denial.

18 Business Plan or Business Resume: Brief narrative on your business experience and history. 19 Current Bank Statement: Provide Copies of current bank statements verifying Cash Accounts as shown on Financial Statements.

DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Development Economic Revolving Loan Fund ## APPLICATION FOR SMALL BUSINESS ECONOMIC DEVELOPMENT LOAN Individual Business Partnership Corporation Today’s Date: Applicant Business Name: NAICS (From Business License): Mailing Address (Street/PO Box, City, State, Zip Code) SSN/EIN: Business Telephone Number: Applicant Name (Last, First, M. I.)

Applicant’s Telephone Number Mailing Address (Street/PO Box, City, State, Zip Code) Married (Including separated) Not Married (Single, divorced or widowed) Date of Birth Place of Birth: (City & State) Number of Dependents (Excluding applicant) Applicant’s Employer: Occupation/Position: Employer’s Telephone Number: How long at present position?

Years Months Gross Monthly Salary (before deductions): Spouse/Co-Applicant Name: (Last, First, M. I.) Social Security Number Mailing Address (Street/PO Box, City, State, Zip Code) Date of Birth Employer’s Telephone Number: Spouse/Co-Applicant’s Employer Occupation/Position: Gross Monthly Salary (Before deductions): How Long at Present Position?

Years Months Nearest relative not living with you/Contact Person Name : (Last, First, M. I.)

Telephone Number: Mailing Address (Street/PO Box, City, State, Zip Code) DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund (Attach additional sheets as necessary) > Applicants Name: SSN/EIN:  I am applying for a loan in the amount of $ ________________________ to be repaid in Describe in detail the project for which you are requesting a loan and your future plans for the business.

Include any information you consider significant in determining the merits of this request, including plans, maps, charts, drawings, reports, etc. DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund ## PROJECT ENVIRONMENTAL QUESTIONNAIRE Please complete the following questionnaire regarding the project you are seeking to finance.

The questionnaire must be completed in its entirety and additional information may be requested once the answers are reviewed. The application will not be processed unless all questions are answered. 1.

Are there properties listed on, or nominated to, or eligible for nomination to the National Register of Historic places on the project site, or in the vicinity of the proposed activity? Yes No 2. If yes, does the proposed action have an effect on the properties?

Yes No If yes, briefly describe effect and how determination was made: 3.

Have activities on the proposed project site, past or present, whether conducted by current owner or previous owner, ever included the following: gas station, car washes, vehicle maintenance or repair, auto dealer, auto body shop, wrecking or salvage yard, chemical manufacturing or storage, metal plating, electronic component manufacturing, machine shops, dry cleaning, tanning, coal, gas, tar, asphalt, electrical substations, sand or gravel pits, farming, landfills, or junkyards.

Yes No 4. Identify and attach copies of all environmental or land use licenses, permits, approvals, certifications, notices, or filings that are required by any governmental agency for applicant’s business. 5.

Does business operations involve the generation, treatment, storage, or disposal of any hazardous wastes or 6. Are any hazardous substances or wastes transported to, from, or stored at the proposed site? 7.

Has an environmental site audit, history, review, or other assessment ever been performed at the proposed site? If yes, attach copies if available. Yes No 8.

Are there or were there ever any above ground or underground oil or chemical tanks on the proposed site? If yes, indicate the number, type and location in separate attachment. Yes No 9.

Does the proposed site contain any wastewater treatment lagoons or lagoons for the storage or treatment of any If yes, describe age, capacity, nature of lagoons, and attach certifications: DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund Please complete the following questionnaire regarding the project you are seeking to finance.

The questionnaire must be completed in its entirety and additional information may be requested once the answers are reviewed. The application will not be processed unless all questions are answered. 10.

Has there ever been a release or the potential for release of oil or any other hazardous wastes at the proposed If yes, please identify locations, dates, and briefly explain: 11. Does the proposed project site contain any asbestos? Yes No If yes, please identify the location: 12.

Does the proposed project site contain, or is adjacent to any wetlands? Yes No If yes, please identify locations: 13. Will there be any air pollution or hazardous emissions into the atmosphere?

Yes No If yes, list type of emission and location: 14. Has the applicant or proposed project site ever been subject to any government enforcement or compliance action or proceeding related to any environmental or land use laws or regulations? Yes No 15.

Is the applicant or guarantor aware of any environmental problems or potential environmental problems at any Location involved in the project to be financed? Yes No If yes, explain in detail: 16.

Is the applicant aware of any significant environmental impact that might occur from the activities of the proposed If yes, please explain: DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund ## PROJECT FUNDING SUMMARY SOURCE OF FUNDS: List below the source of all funds that will be invested in the project for which you are requesting financing.

The total will be the total project cost. Small Business Economic Loan $ Cash to be invested by appl icant (cannot include monies invested prior to submission of loan application) Loans from other Government sources (Describe) : $ USE OF LOAN PROCEEDS: Describe below how the loan proceeds will be used. Attach copies of earnest money agreements, contractor’s bids, contracts, invoices or other documentation to verify these uses.

Total must equal loan amount requested. If your loan is approved, you will need to provide documentation to verify the total project cost. USE OF FUNDS FROM OTHER SOURCES: Describe below how you will use funds from other sources to complete your project.

Attach copies of earnest money agreements, contractor’s bids, contracts, invoices or other documentation to verify these uses. The total of these funds and the loan proceeds listed above must equal the Total Project Cost listed under sources of funds.

Total Use of Funds From Other Sources $DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund 1 When was this business established? List below all owners and their percent of ownership (Please add additional sheets if necessary). Ownership total must equal 100%.

All individuals owning 20% or more of the business must complete an individual financial statement and will be required to sign loan documents. 3 Is this business minority owned (at least 51% owned by African-Americans, Hispanics, Asians, Alaska Natives, and/or Indians)? 4 Is this a woman-owned business (at least 51% owned by a woman)?

Yes 5 List subsidiaries and/or affiliated companies. Explain trade and financial interrelationships of applicant and such subsidiaries and/or affiliates: 6 What are the principle products or services your business provides?

7 Attach a copy of your business plan or provide information relating to markets, your marketing plan, potential customers’ cash flow analysis, etc. 8 Attach personal resumes of applicants and key managers of the business. JOB INFORMATION: Loans made under this program must result in the creation or retention of jobs within an eligible area. Please provide the job related information listed below.

If your loan is approved you will be required to provide similar information on an annual basis. 1 If this loan is approved, will jobs be retained that would have otherwise been lost? Yes No 2 If “yes” to question number 1, how many jobs will be retained?

a How many of those retained are held by women? b How many are minorities? 3 If this loan is approved, will new jobs be created?

Yes No 4 If “yes” to question number 3, how many jobs will be created? a How many of those jobs created could potentially be held by women? b How many of those jobs created could potentially be held by minorities?

DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund FINANCIAL STATEMENT (INDIVIDUAL) Name (Last, First, M. I.) Social Security Number: Date: Mailing Address (Street/PO Box) City: State: Zip Code The undersigned makes the following statement of financial condition as of day of ,20 .

Notes/Accounts Receivable (Schedule 1) Accounts Payable U.S. Bonds or Notes Other Liabilities Value of Real Estate Owned TOTAL ASSETS $ TOTAL LIABILITIES $ Yes Are you a co-maker, endorser, or guarantor on any loan or contract? Yes Are there any unsatisfied judgments or collections against you? If “yes,” attach letter of explanation.

Amount $ No Yes Have you filed for bankruptcy in the last 14 years? If “yes,” attach letter of explanation.

Year No Personal Living Expenses and Other Obligations (Child Support, Alimony, etc.) Amount $DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund ## FINANCIAL STATEMENT (INDIVIDUAL) SCHEDULE NO. 1: NOTES RECEIVABLE/ACCOUNTS RECEIVABLE, MORTGAGES & CONTRACTS OWNED Description Name of Debtor Original Balance Present Balance Monthly Payment Amount Past Due SC HEDULE NO. 2: SECURITIES # of Shares Description To Whom Pledged Market Value Cost Income Received Last Year SCHEDULE NO. 3: REAL ESTATE OWNED Description & Location (Street, City, State) Is any real estate being purchased on a contract of sale?

Yes No If so, which one? SCHEDULE NO. 4: NOTES PAYABLE (Do Not Include Mortgages Listed in Schedule 3) > Name & Address of Banks Present Amount When Due Payment Amount Have you ever received a loan from the state?

Yes No If yes, please complete the following: Loan Number Loan Type Date Received Paid in Full Yes No DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund FINANCIAL STATEMENT (BUSINESS) Mailing Address (Street/PO Box) City: State: Zip Code: The undersigned makes the following statement of financial condition as of day of , 20 .

Cash in Bank $ Real Estate (Schedule 3) $ $ Cash on Hand Notes Payable (Schedule 4) Notes/Accounts Receivable (Schedule 1) Accounts Payable Less: Reserve for Bad Debts Employer Taxes Payable U.S. Bonds or Notes Other Taxes Payable Mortgages & Contracts (Schedule 1) Other Liabilities (Itemize) Value of Real Estate Owned (Schedule 3) Machinery, Furniture & Fixtures Total Monthly Payments $ $ TOTAL ASSETS TOTAL LIABILITIES $ Yes Are you a co-maker, endorser, or guarantor on any loan or contract?

Yes Are there any unsatisfied judgments or collections against you? If “yes,” attach letter of explanation Amount $ No Yes Have you filed for bankruptcy in the last 14 years?

If “yes,” attach a letter of explanation Year No Other Obligations: Amount $DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund FINANCIAL STATEMENT (BUSINESS) SCHEDULE NO. 1: NOTES RECEIVABLE/ACCOUNTS RECEIVABLE, MORTGAGES & CONTRACTS OWNED Description Name of Debtor Original Balance Present Balance Monthly Payment Amount Past Due SCHEDULE NO. 2: SECURITIES # of Shares Description To Whom Pledged Market Value Cost Income Received Last Year SCHEDULE NO. 3: REAL ESTATE OWNED Description & Location (Street, City, State) Is any real estate being purchased on a contract of sale?

Yes No If so, which one? SCHEDULE NO. 4: NOTES PAYABLE (Do Not Include Mortgages Listed in Schedule 3) Name & Address of Bank Collateral Date Incurred Present Amount When Due Payment Amount Have you ever received a loan from the state?

Yes No If yes, please complete the following: Loan Number Loan Type Date Received Paid in Full Yes No DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund All loans must be adequately secured. The loan amount may not exceed 90% of the value of the collateral securing the loan.

In many cases the amount loaned may be less than 90% depending on the type of collateral utilized. Please list below the collateral you are offering. You must also indicate the method used to value this collateral and include supporting documentation such as appraisals, assessment notices, opinions of value or invoices, bids or other documentation to support cost valuations.

> Collateral Description Value Maximum Collateral % Collateral Value Existing Liens Adjusted Value Land $50,000. 00 85% $42,500. 00 10,000.

00 $32,500. 00 Building $100,000. 00 85% $100,000.

00 0 $85,000. 00 Equipment $50,000. 00 50% $50,000.

00 0 $25,000. 00 Vessel $100,000. 00 75% $100,000.

00 0 $75,000. 00 Total Loan Value $292,500. 00 $217,500.

00 > Collateral Description Value Maximum Collateral % Collateral Value Existing Liens Adjust Value Total Loan Value $ $DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund ## ACTUAL STATEMENT OF PROFIT & LOSS Applicant’s Name: SSN/EIN: For the Period Beginning: (Must be within last 12 months) And Ending Beginning Inventory (If Applicable) $ Total Cost of Goods Sold (-) Proprietor’s or Officer’s Salary $ Advertising & Promotion $ Total Operating Expenses (-) TOTAL NET INCOME $Page 13 DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund Estimate all income and expenses for the 12 month period after receiving loan ## PROJECTED STATEMENT OF PROFIT & LOSS Applicant’s Name: SSN/EIN: For the Period Beginning: And Ending Beginning Inventory (If Applicable) $ Total Cost of Goods Sold (-) Proprietor’s or Officer’s Salary $ Advertising & Promotion $ Total Operating Expenses (-) EXPLAIN HOW YOU MADE THE ABOVE PROJECTIONS ON THE NEXT PAGE DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund ## EXPLANATION OF PROJECTED STATEMENT OF PROFIT & LOSS DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund AUTHORIZATION TO OBTAIN CREDIT AND/OR RELEASE INFORMATION I authorize the Division of Investments to obtain information from, or release any information contained in my loan application and attachments to the following agencies: U.S. National Marine Fisheries Service Alaska Department of Fish and Game Alaska Commercial Fisheries Entry Commission Alaska Child Support Enforcement Division Alaska Department of Transportation and Public Facilities Alaska Permanent Fund Dividend Division Alaska Department of Public Safety Alaska Post Secondary Education Alaska Division of Motor Vehicles I further authorize any individual or institution to release credit information concerning me to the Division of Investments.

This authorization is given to enable the Division of Investments to evaluate my loan request. Verification may be obtained from any source named in this application and from any credit-reporting agency. I understand additional information may be requested as part of the quality control program at any time during the lending process.

It is understood that a photocopy of this form will serve as authorization.

> Applicant’s Signature: Co-Applicant Signature: > Please Print Name: Please Print Name: > Social Security Number: Social Security Number DIVISION OF INVESTMENTS Department of Commerce, Community, and Economic Development Small Business Economic Development Revolving Loan Fund I understand and agree that if I submit any false, inaccurate, or incomplete information in this application and attachments, I will be subject to the following: / My application will be denied.

/ If I receive a loan based on the false, inaccurate, or incomplete information, and this information is disclosed in the future, the loan will be canceled and immediately payable. a) I certify that I have not been debarred or suspended from receiving benefits from any federal programs. I certify under penalty of perjury that all the information provided in this application and attachments is true, accurate and complete.

I am aware that the maximum penalty for perjury, a Class B felony under AS 11. 56. 200(c), is a fine of up to $50,000 (AS 12.

55. 035(b)(2)) and imprisonment for up to 10 years (AS 12. 55.

125(d)).

Applicant’s Signature: Date : Applicant’s Signature: Date : The foregoing instrument was acknowledged before me this day of , 20 _________ By (Name of person(s) who acknowledged): ___________________________________________________________ > ________________________________________________ My Commission Expires: __________________________ If you become aware of inaccurate or incomplete information which is contained in your application, you should submit a written request to the Director of the Division of Investments which contains the following information: A description of the challenged information Changes necessary to make the information accurate or complete APPLICANT'S PRINTED NAME(s)