Date:___________
SHARE account #___________________________________________________
Amount and term of loan: $__________________for________________months
Name:____________________________________________________________
Home address:_____________________________________________________
Please feel free to use additional pages to answer any questions
Briefly describe your project:
Explain briefly how you anticipate that the use of this loan will provide any or all of the following benefits to the local community; 1) increase employment; 2) reduce dependency on outside sources of food, energy, building supplies, clothing or other basic necessities; 3) improve the quality of the environment; 4) provide a needed service or product to the community which is not either being provided at all, or which is inadequately provided at present – including social or cultural services.
If the loan application is not to an individual, explain the structure of your company or organization and describe any participation of members in decision-making. If a business, does it include participation in the ownership by workers or are there plans to do so?
PROJECT FINANCES
Funds are required for (purpose) :
a.__________________________________________________ $_______
b.__________________________________________________ $_______
c.__________________________________________________ $_______
d.__________________________________________________ $_______
e.__________________________________________________ $_______
TOTAL FUNDS REQUIRED $________________
Source of funds:
a. Loan from bank collateralized by SHARE $_______
b.__________________________________________________ $_______
c.__________________________________________________ $_______
d.__________________________________________________ $_______
TOTAL FINANCING $________________
Current loans for project (use additional paper if necessary):
Name of lender, Security held, Repayment terms, and any Loan amount arrears:
Anticipated Project income for next year:
Gross $ _______________________________ Net $___________________________
Source of Income:
a.__________________________________________ $___________________
b.__________________________________________ $___________________
c.__________________________________________ $___________________
Gross Project Income $________________
Anticipated Expenses for the next year:
a.__________________________________________ $___________________
b.__________________________________________ $___________________
c.__________________________________________ $___________________
d.__________________________________________ $___________________
Total anticipated expenses for the next year $ _______________
* Net Income from project with which to pay back loan
(Gross yearly income minus yearly expenses) $ ___________________