Revolving Loan Agreement Form Page 2
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2The following information must be submitted with application:
Page Two
A copy of the Certificate of Incorporation.
A copy of the organization’s IRS not-for-profit tax-status determination ruling and a letter confirming that its 501c(3)
status is still in effect.
A list of the Board of Directors, including Board titles and addresses.
A copy of the most recent financial report or audited statements.
A copy of the approved contract or grant award letter.
A resolution from the Board of Directors authorizing the loan.
REPAYMENT PROCEDURE: The grant funding agency will send the portion of the grant due as loan repayment directly to
NYFA at 20 Jay Street, Suite 740, Brooklyn, NY 11201. The loan repayment check will be made out to NYFA and the
organization will be notified of its repayment. A grant check will be issued directly to the organization by the agency
representing the difference between the grant and the loan. THE BORROWER MUST CALL NYFA UPON RECEIPT OF
THEIR AGENCY CHECK
The Borrower represents and warrants that, in making this application, it has had the opportunity to obtain the advice of legal
counsel, and also that there are no pending agreements, transactions or negotiations to which it is a party which would affect
the validity or enforceability of this Agreement.
I hereby certify that all information in the application is true and complete to the best of my knowledge and is given for the
purpose of obtaining a loan. I expressly authorize any individual, bank association, company or human resources department
contacted by NYFA to furnish information concerning the organization or its personnel. This application shall be the property
of NYFA whether or not a loan is made.
FOR BORROWER:
Chairman of the Board of Directors:
________________________________________________
_____________________________________
Name (please print)
Social Security Number
________________________________________________
_____________________________________
Signature
Date
Chief Executive Officer:
________________________________________________
_____________________________________
Name (please print)
Social Security Number
________________________________________________
_____________________________________
Signature
Date
Chief Financial Officer:
________________________________________________
_____________________________________
Name (please print)
Social Security Number
________________________________________________
_____________________________________
Signature
Date
FOR LENDER
________________________________________________
_____________________________________
Date
FOR AGENCY:
________________________________________________
_____________________________________
Signature
Date
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