SHARE account #___________________________________________________


Amount and term of loan: $__________________for________________months




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?






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)                       $ ___________________