222 Mulberry StreetP.O. Box 431Scranton, PA 18501-0431

Not Sure Which Way to Turn for Small Business Financing?

When banks can’t help...MetroAction CAN!

Serving : Carbon Lacka

wanna

Lu

zern

e M

onro

e P

ike

Susquehanna, Wayne or Wyoming counties

Susquehanna W

ayne Wyoming Counties

You can apply for up to $50,000 for any of these uses:

• Start-up expenses • Machinery or equipment • Working capital

Most small businesses in northeastern Pennsylvania are eligible to apply – even if you don’t qualify for bank financing. The applicant must:

• Have less than 50 employees • Earn less than $1 million in annual sales • Be located within Carbon, Lackawanna, Luzerne, Monroe, Pike, Susquehanna, Wayne or Wyoming counties

• Submit this completed application along with the credit analysis fee or apply on- line 24/7 at www.MetroAction.org • You will be contacted within 48 hours and provided with the next steps • The entire application process may take up to 30 days When Banks Can’t Help…MetroAction Can! APPLY TODAY!

• Renovations • Gap financing

222 Mulberry St. PO Box 431Scranton, PA 18501

24 Hour Loan Information Line (570)342-7711 ext. 222www.MetroAction.org

What Can I Use the Loan For?

Am I Eligible?

How do I Apply?

Loan Pre-Qualification Application

Business InformationBusiness Name County

Mailing Address Web Address

City State Zip

Products or Services Sold Number of Business Owners

Business Phone( )

Cell Phone( )

E-Mail Address

Loan RequestAmount Requested$

Are you willing to accept less? Yes No If yes, what is the minimum amount you will accept?$

Intended Use of Funds Who Referred You to MetroAction?

Machinery/Equipment $ Small Business Development Center Internet/Website

Leasehold Improvements $ Chamber of Commerce Newspaper

Inventory Purchases $ Small Business Administration TV

Accounts Payable $ Government Agency Radio

Start-up Capital $ Bank: _____________________ Family/Friend

Business Acquisition $ Other: _____________________ Brochure

Other: $

Collateral

Personal Real Estate$

Whole Life Insurance$

Business Real Estate$

Vehicle$

Machinery/Equipment$

Other Business Assets$

Inventory$

Other:$

Stocks, Bonds, Security $ None

*Investments pertaining to retirement accounts cannot be used

Business Cash Flow

Business Cash Flow (if start-up, you may use projections)

Average Gross Monthly Sales: $

Average Gross Monthly Expenses: $

BE SURE TO COMPLETE PAGE 2

Instructions:Each person who owns 20% or more of the business must complete this application in order to be considered.

All financial information can be filled in with estimates. However, if you are pre-qualified for financing, we will then ask for a complete and accurate financial statement and personal balance sheet from each applicant and/or guarantor.

Please submit this application and the $20 non-refundable credit analysis fee (per applicant/guarantor) to MetroAction, Inc., 222 Mulberry Street, PO Box 431, Scranton, PA 18501 or if paying by credit card, fax to (570) 347-6262 .

For more information on our small business financing or training programs, or to receive help in completing this application, call (570) 341-0270 or visit our website, www.MetroAction.org.

In most cases, collateral is required as security for each loan request. Please include values for ALL sources of collateral that are available. Providing incomplete information will delay pre-qualification processing.

“MetroAction, Inc. is an equal opportunity provider, employer and lender.”

EACH APPLICANT AND/OR GUARANTOR MUST COMPLETE THIS PAGE AND INCLUDE THE $20 CREDIT ANALYSIS FEE. If there is more than 1 business owner (20% or more ownership of business), this form must be photocopied and

completed in its entirety.Personal InformationLast Name First Name Date of Birth Social Security Number

Home Address City State Zip

Home Phone ( )

Cell Phone( )

% Ownership Title Are you a veteran of the armed forces? Yes No

Are you a U.S. citizen, or do you have a green card or other proof of residence? Yes No

Personal Cash FlowTotal Monthly Income From All Household Sources: $Total Monthly Household Expenses: $

Personal Assets & Liabilities

Personal Assets Value (estimated) Personal Liabilities (estimated)

Cash on Hand: $ Total Credit Card Balance: $Savings/Checking/Stocks, etc.: $ Total Bank/Student Loans Balance: $Real Estate (Current Market Value): $ Total Mortgage Balance: $Automobile: $ Total Auto Balance: $Life Insurance: $ Other Liabilities: $Other Assets: $ (Please use the balance as listed on your last statement)

Authorization and Certification

Signature Date

Payment InformationOnly applications completed in their entirety, including $20 non-refundable credit fee per applicant, will be considered.

Make checks payable to "MetroAction, Inc."

Payment Method (check one): Check Mastercard Visa American Express Discover

Total Amount Due: $ ($20 per applicant/guarantor)

Credit Card Number: Exp Date:

Name on Card: V-Code:

Address:

For Office Use Only: Date Rcvd: ___/___/___ By: _______ Date Processed: ___/___/___

Please include estimated up-to-date values for ALL assets and liabilities. Providing incomplete information will delay pre-qualification processing.

I authorize MetroAction to make inquiries as necessary to verify the accuracy of the statements made to determine my credit worthiness through a personal credit check. I hereby certify that all information contained in this document and any attachments is true and correct to the best of my knowledge.