CAP Enrollment Form


Lender Information

Name of Lender

EIN #

Reserve Account #

Loan Officer Information

Name

Position

Email

Phone

Street

City, State, Zip

Fax

Borrower Information

Contact

Company Name

Street

City, State, Zip

Phone

Fax

Annual Sales

Year Incorporated/Started

SIC Code

NAICIS Code

No. of Current Employees

Est. of Jobs Created

Est of Jobs Retained

Total of other indebtedness

Minority Owned

Woman Owned

Disabled

Veteran

Loan Information

Lender Loan No

Total Loan Amount

Covered Loan Amount

Borrower/Lender Pmt

Maturity (Months)

Interest Rate (APR)

Date loan funds available

Date reserved pmt. deposited

Purpose

Loan Type: TermLine

NOTE: SBA guaranteed loans are not allowable.

Fill out the following items ONLY IF REFINANCING A PROGRAM LOAN (Note: New covered loan amount less prior amount enrolled must equal covered amount of this loan):

Prior amount of loan enrolled

Balance at time of refinancing

New total covered loan amount

In filing this loan for enrollment, the lender makes the representations and warranties specified for the Lender in Section 2.2 of the Agreement between the Lender and BDC Capital, as agent for the Massachusetts Office of Business Development.

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