Clinch-Powell Rural Small Business Loan Fund Fact Sheet
Eligible Areas: Grainger, Claiborne, Hancock, Hawkins, Union, Jefferson, Greene, Cocke,
Campbell and rural areas of Hamblen and Knox counties in Tennessee.
Loan Fund Purpose: To stimulate economic development in rural East Tennessee. The loan
fund will provide affordable financing to small businesses and entrepreneurs located in rural East
TN areas meeting USDA RD definitions.
Eligible Uses of Funds: Equipment, real property, contracted materials (with some limitations).
General operating funds, inventory and investments are not eligible. Limitations on some
agricultural purposes.
Security: Loans require acceptable collateral.
Interest Rate: Below market, based on credit score, loan amount, security
Loan Limits: Up to $45,000
Loan Terms: Depends on loan purpose, amount and collateral.
How to Apply for a Loan: Submit a completed loan application and Basic Business Plan for
consideration. Loan application can be downloaded from Quick Links at www.clinchpowell.net
Contact: For more information, contact Lindy Turner, Clinch-Powell RC&D Council, Inc.
865-828-5927, lindy@clinchpowell.org
Part I: Business Application
Section A: Business Information
Is the company registered to do business in the state of Tennessee? Yes No
Legal structure of business: Sole Proprietor Partnership LLC Corporation S-Corporation
Legal Name of Business: DBA Name (if any):
Mailing Address: County:
City: State: Zip (+4):
Physical Location Address (if different):
Business Phone: Business Fax: Business Website:
Business TIN/ FEIN: Ave. Monthly Sales: $ Ave. Annual Sales Last 3 YRS: $ Time in Business: _____ Years _____ Months Related Industry Experience: _____ Years _____ Months What are the products/services offered by this business?
Section B: Employee Information
List the ethnicity, race, gender and nationality for all employees (names not required). Do not include 1099 subcontractors.
Employee Title Ethnicity Race Gender Nationality
Ethnicity: Hispanic/Latino (L); or Not Hispanic (H) | Race: White (W); Black/African American (AA); American Indian/Alaska Native (NA); Asian (A); Native Hawaiian/Other Pacific Islander (OP) | Gender: Male (M); Female (F) | Nationality: Country of citizenship or nationality (example, USA)
Section C: Proposed Collateral
Directions: List all potential sources of collateral. Provide model numbers, serial numbers, other ID numbers, the year it was acquired, purchase price and current estimated value. Only list items that you own outright. You must possess the original title (in your name) on all proposed vehicles, trailers, etc. Applications with proposed collateral that meets or exceeds the loan request amount are preferred.
Item Year
Acquired Make/Model
VIN Number/Serial Number
(Do you have the original title in your name?) Purchase Price Current Estimated Value Where is collateral stored?
Part II: Borrower Application
Each person with 20% or more ownership of the business must complete a Borrower Application, Sections I – IV and sign and date. Section I: Applicant Information
Percentage of Ownership: % Do you own more than 20% of any other business? Yes No
Last name: First name: Middle Initial:
Residence mailing address:
City: State: Zip (+4):
Primary Telephone Number: Other Phone Number:
Primary Email Address: Other Email:
Driver’s License Number (or legal photo ID): State: Expiration (mm/dd/yyyy):
Do you rent or own? (if you live with someone else select
rent) Rent Own How long? _____ Years _____ Months
Place of birth:
(city, state or foreign country) Date of birth: (mm/dd/yyyy) Social Security:
Citizenship: If not U.S., Type of VISA or alien registration:
Section II: Personal Financial Statement
This personal financial statement was completed on (date): How much are you requesting on this loan application? ($20,000 max.) $
Assets (Omit Cents) Liabilities (Omit Cents)
Cash on hand in bank(s) $ Accounts Payable
(including credit cards) $
Saving account(s) $
Notes Payable to Banks and Others:
(Describe in “Real Estate Owned” below) $
IRA or Other Retirement Account $ Secured: $
Accounts & Notes Receivable $ Unsecured: $
Life Insurance (cash surrender value only) $ Installment Account(s): $
Stocks and Bonds
(describe below) $
Installment Account(s) – Auto
Monthly payment: $ ______ $
Real Estate
(describe below) $
Installment Account(s) – Other
Monthly payment: $ ______ $
Automobile-Present Value
(use Kelly Blue Book Trade-in “Fair” Value) $
Mortgage Debt on Real Estate
(describe below) $ Personal Property (describe below) $ Taxes Payable (describe below) $ Other Assets (describe below) $ Other Liabilities (describe below) $
Total Assets: $ Total Liabilities $
Describe any assets and/or liabilities here.
Annual Source of Income Contingent Liabilities
Salary $ As Endorser or Co-Maker $
Investment Income $ Claims & Judgments $
Real Estate Income $ Provision for Federal Income Tax $
Other Income* $ Other Special Debt $
Total annual income: $ Total contingent liabilities: $
*Alimony or child support payments need not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income.
Describe annual sources of income and/or contingent liabilities in this space:
Notes Payable to Banks and Other
(Use attachments if necessary. Each attachment must beidentified as part of the statement and signed.)
Name and Address of Noteholder(s)
Original Balance Current Balance Payment /month (week)
Secured? How Secured or Endorsed Type of Collateral
Yes No
Real Estate Owned
(List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed.)
Primary Residence Property B Property C
Type of Property
Physical Address Date Purchased Original Cost Present Market Value Mortgage Balance Amount of Payment per
Month/Year Status of Mortgage
Section III: Monitoring Questions
Are you in default on a federal student loan or on any type of government loan? Yes No
Have you ever been convicted of a felony? Yes No Are you or any of your company’s officers, major shareholders or partners, or the spouses or
close relative of such individuals presently employed by the State of Tennessee? Yes No If so, please explain:
Will any of the loan proceeds be used for construction, breaking ground, constructing a
building, etc.? Yes No
The following information is requested by the federal government for certain types of loans, in order to monitor the lender’s compliance with equal credit opportunity. You are not required to furnish this information, but are encouraged to do so. The law requires that a lender may neither discriminate on the basis of this information nor on whet her you chose to furnish it. However, if you choose not to furnish it, under federal regulations, this lender is required to note race/ethnicity on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below.
Gender Male Female
Ethnicity African American Asian-Pacific Islander Caucasian
Hispanic/Latino Native American Refugee
Highest Level of Education Completed: Less than 9th Grade Some High School High School Graduate/GED
Some College College Graduate
Do you have health insurance? Yes No
Are you physically disabled? Yes No
Are you a veteran of the United States Armed Forces? Yes No
I do not wish to furnish this information.
Federal Equal Credit Opportunity Statement
Federal law does not allow discrimination of any kind. You cannot be denied a loan because of your race, color, religion, national origin, sex, marital status, handicap, or age (if you can legally sign a contract). You cannot be denied a loan because all or part of your income is from a public assistance program. If you believe that you have been discriminated against for any reasons, you can write the secretary of Agriculture, Washington, D.C. 20250. You cannot be denied a loan because you exercised your rights under the Consumer Credit Protection Act. You must have exercised these rights in good faith. The Federal Agency responsible for seeing this law is obeyed is the Federal Trade Commission, Washington, D.C. 20580.
Section IV: Certificate of Eligibility I hereby certify to the best of my knowledge that:
o I am eligible to participate in the Clinch-Powell RC&D Council, Inc. Rural Small Business Loan Program and sign below as Principal and Guarantor, and
o I intend to establish or expand a small business enterprise in a rural area of Tennessee. and
o My business has fewer than 10 employees including the owners, and
o I have established that I have financial need, am financially sound and capable of repaying the monies I borrow under this loan program, and
o I have completed a business plan and small business training from a Tennessee Small Business Development Center or other approved training provider, and
7995 Rutledge Pk | Rutledge, TN 37861 | ph: 865.828.5927 | f: 865.828.5212 | www.clinchpowell.net
Clinch-Powell RC&D Council, Inc. is a 501C3 not-for-profit organization and an equal opportunity employer and provide. All programs and assistance of the RC&D Council are available without regard to race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status.o I agree to have my application reviewed by representative(s) from participating lenders including bank and USDA, and
o I authorize RC&D to utilize credit bureau/reporting agencies and/or its own agents for purposes of verifying the accuracy of any information provided by borrower and for purposes of assessing and monitoring borrower credit status, and
o If the loan is awarded, all proceeds will be used strictly for business purposes, and
o If the loan is awarded, the company concurs understanding of the USDA and State of Tennessee’s Comptroller office’s opportunity to audit program spending, and
o As a recipient of federal funds, I agree that my business will comply with Title VI regulations, and
o This application may only be modified as approved in writing by the loan manager. No other representative of RC&D or other agency is authorized to make any verbal or written modification to this application, and
o All the information provided herein is true and accurate.
Applicant signature:
Print name: Date:
CONSENT TO RELEASE & VERIFY INFORMATION
As a participant in the Clinch-Powell Rural Business Loan Program, I authorize Clinch-Powell RC&D Council, Inc. to use my Social Security number for the purpose of obtaining my credit report for the purpose of evaluating my credit history. I also authorize the release of my credit report to Clinch-Powell RC&D Council, Inc. by those credit reporting agencies from which Clinch-Powell RC&D Council, Inc. may request my credit report.
I understand that the information on my credit report will be used by Clinch-Powell RC&D Council, Inc., its affiliates, lenders, USDA Rural Development, only for the purpose of determining my qualification for a business loan and my eligibility for assistance. This information will not be disclosed to any other third parties without my consent.
Applicant signature:
