USVI Public Records

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1 of 6 Rev. 3/17/2017 INITIALS: _______ Referred by: ____________________________________________ Agency: _______________________________________________ Promoter: ______________________________________________ Individual’s Social Security Number: _______________________ Date of Birth: ___________________________________________ Business EIN No.: _______________________________________ Telephone Number: _____________________________________ Fax Number: ____________________________________________ Email Address: _________________________________________ 1. APPLICANT (COMPANY): ___________________________________________________ ___________________________________________________ 2. CONTACT PERSON: Name: ____________________________________________ Position: __________________________________________ 3. PHYSICAL ADDRESS: ___________________________________________________ ___________________________________________________ City State Zip Code 4. MAILING ADDRESS: ___________________________________________________ ___________________________________________________ City State Zip Code 5. USE OF FUNDS: a. Construction of Building Improvements $ ______________ b. Purchase of Machinery & Equipment $ ______________ c. Working Capital $ ______________ d. Others (Describe on separate sheet) $ ______________ TOTAL AMOUNT REQUESTED $ ______________ Total Cost of Project $ ___________________________________ Business Owner(s) Investment (25% minimum) $_________________ Term (years): ____________________________________________ 6. AFFILIATED BUSINESS (if any): Physical Address: ____________________________________ ___________________________________________________ City State Zip Code Mailing Address: _____________________________________ ___________________________________________________ City State Zip Code 7. COMPANY DATA: Type of Business:  For Profit Corporation  Partnership  Individual  Other Date established: Date operations began: ____________________ ___________________________ Describe the industry in which you operate or intend to operate: __________________________________________________ __________________________________________________ 8. FACILITIES: Owned: _____________________ Leased: _____________________ Lessor: _____________________ Monthly Fee: _____________________ Length of Contract: _____________________ 9. NUMBER OF EMPLOYEES: Current: Projected Growth: 10. TAX EXEMPTION: a. Have you applied for tax exemption? Yes  No  b. When? _____________________________________________ c. If your business received tax exemption, indicate: Date: _________________________________ Period covered: _________________________________ LOAN APPLICATION ECONOMIC DEVELOPMENT BANK Please fill in all the blanks and initial each page in the upper right-hand corner. U.S. Virgin Islands Economic Development Authority (USVIEDA) Economic Development Bank Loan Application 2 of 6 Rev. 3/17/2017 INITIALS: _________ 11. Collateral offered as guarantee: Description/Location Date Acquired Original Cost Actual Value Estimated Value Mortgage Holder Mortgage Balance 12. Banking and Commercial References: a. Include banking references and at least four (4) commercial references. You should indicate the account numbers and references, as well as the complete address. Name Account Number or Reference Mailing Address Telephone b. Other sources of credit for your company or business Suppliers Tern Maximum Credit Maximum Credit Used Telephone 1. 2. 3. 4. c. Does the applicant, guarantor, stockholder, or main officers have, or ever had, a pending application with any of the entities mentioned below? Financial Institution Account Number Year Original Amount 1. Small Business Development Agency 2. Government Development Bank 3. Small Business Administration 4. Commercial and Agricultural Credit 5. Other U.S. Virgin Islands Economic Development Authority (USVIEDA) Economic Development Bank Loan Application 3 of 6 Rev. 3/17/2017 INITIALS: _______ 13. Names, stockholders and contributed capital (include financial statements): Name and Position Citizenship Social Security Contributed Capital Telephone Quantity (%) 1. Spouse 2. Spouse 3. Spouse 4. Spouse If you answer “Yes” to questions 14 through 16, please explain in a separate sheet of paper. 14. Judicial lawsuits, tax lawsuits, bankruptcy a. Is there any lawsuit pending or filed against the company, business, its owner, stockholders, guarantors, or company officers? Yes  No  b. Has the firm, its main stockholders, guarantors, key officials or the business owner ever been subject to bankruptcy or insolvency proceedings? Yes No c. Do you owe any income or property tax? Yes No  NOTE: You must submit certification from the Bureau of Internal Revenue (Internal Revenue Collector’s Office) and a copy from the Department of Finance or copies of paid property tax bills. 15. Have the principals, stockholders, guarantors or main officers ever been accused or convicted of any criminal offense besides violation to traffic laws? Yes No 16. Does any officer, principal, stockholder, guarantor, business owner, or relative work, or has ever worked for GDB/SBDA? Yes  No  17. If the loan is approved, would you object to the use of your name by this Bank for advertising (or public relations) purposes? Yes  No  18. How did you learn about the services of the GDB/SBDA? Television  Newspaper  Radio  Friends  Relatives Co-worker(s) or business partner  New media (e.g. Internet ____, USVIEDA website _____, social media platforms _____, etc.)  Referred by _____________________________________________________ Other __________________________________ Your initial interview was with: _________________________________________________________ Bank Officer U.S. Virgin Islands Economic Development Authority (USVIEDA) Economic Development Bank Loan Application 4 of 6 Rev. 3/17/2017 INITIALS: _______ 19. INFORMATION FOR GOVERNMENT MONITORING PURPOSES: The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender’s compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.) BORROWER I do not wish to furnish this information CO-BORROWER  I do not wish to furnish this information ETHNICITY Hispanic or Latino Not Hispanic or Latino ETHNICITY Hispanic or Latino Not Hispanic or Latino RACE  American Indian or Alaska Native Asian  Black or African American White Native Hawaiian or Other Pacific Islander RACE  American Indian or Alaska Native Asian  Black or African American White Native Hawaiian or Other Pacific Islander SEX  Female  Male SEX  Female  Male 20. Use of intermediaries: If you submit your loan application through an intermediary, please give us the following information and include copy of contract, if any: Name: _________________________________________________ Company: ________________________________________________ Address: _______________________________________________ Position: _________________________________________________ __________________________________________________ City State Zip Code Fee: $ __________________________________________________ Social Security Number: ______________________________________ I hereby authorize the U.S. Virgin Islands Economic Development Authority to supply information to the information to the intermediary stated above. Authorized Signature ___________________________________________________ Date _____________________________________________ Position _____________________________________________________________ 21. Auditing Firm ____________________________________________________________________________________________________________ (Name of Auditing Firm) Telephone No.: ___________________________________________________ Date ___________________________________________________ I authorize the USVI Economic Development Authority to contact my auditors, if necessary. Authorized Signature ___________________________________________________ Position _________________________________________ U.S. Virgin Islands Economic Development Authority (USVIEDA) Economic Development Bank Loan Application 5 of 6 Rev. 3/17/2017 INITIALS: _______ CERTIFICATION I certify that I have filed tax forms and that I have made the corresponding payment or taken advantage of a payment plan. __________________________________ Authorized Signature __________________________________ Title ______________________________ By filing this application, the signer guarantees the veracity of the information submitted and of any other information submitted in the future, in order for the Bank to rely in it and thus extend credit to the applicant. The applicant also certified that no information concerning the credit risk involved has been withheld. Inducing the USVIEDA to grant a loan through fraudulent information constitutes a crime under the law of the Government of the Virgin Islands. Signed in ______________________________________________ ______________________________________ 20_____ Company ______________________________________________ By: ___________________________________________________ Title __________________________________________ (Authorized Signature) FOR EXTERNAL USE ONLY DATE APPROVED: ____________________________ USVIEDA OFFICER: _________________________ U.S. Virgin Islands Economic Development Authority (USVIEDA) Economic Development Bank Loan Application 6 of 6 Rev. 3/17/2017 Credit Application Notifications Thank you for your loan application with U.S. Virgin Islands Economic Development Authority – Economic Development Bank. The following loan application disclosures are required by law or regulation and are provided for your information and use. Fair Lending Disclosures If your loan application is denied, you have the right to a written statement of the specific reason for the denial. To obtain the statement, please contact U.S. Virgin Islands Economic Development Authority – Economic Development Bank, 8000 Nisky Shopping Center, Suite 620, St. Thomas, VI 00802, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for a statement. Under the Fair Credit Reporting Act, you are entitled to receive a free copy of your credit report from the agency that provided us with the credit information about you, provided you make a written request of the credit reporting agency within 60 days of your receipt of this notice. You may also dispute with the credit reporting agency the accuracy or completeness of any information contained in your consumer report furnished by that agency. Equal Credit Opportunity Act The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the ability to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that administers compliance with this law concerning this creditor is the: Federal Deposit Insurance Corporation, Consumer Response Center, 1100 Walnut St, Box #11, Kansas City, MO 64106, (800) 378‐9581. Fair Credit Reporting Act Disclosures Information Reported to Consumer Reporting Agencies Under the Fair Credit Reporting Act, you have the right to notify us if you believe we have reported inaccurate information about your account to any Consumer Reporting Agency. Such notices should be sent in writing and include your complete name, current address, Social Security number, telephone number, account number, type of account, specific item of dispute and the reason why you believe the information was reported in error. Send your notice to: U.S. Virgin Islands Economic Development Authority – Economic Development Bank, 8000 Nisky Shopping Center, Suite 620, St. Thomas, VI 00802. The USA Patriot Act The USA Patriot Act has paved the way for financial institutions to help prevent fraud, identity theft, and the spread of terrorism. It requires financial institutions to obtain more information from an individual or legal entity to help establish identity. Your cooperation is needed when you open a new account or request a loan. You may be asked more questions to establish and confirm your identity. It may also be required for you to provide one or more of the following types of identification: Driver’s License, Passport & Country of Issuance, U.S. Taxpayer Identification (ID) Number, Alien ID card, or Any other government issued document evidencing nationality or residence Non‐Discrimination Statement This institution is an equal opportunity provider, employer and lender.