Your social security number will be used only for the purposes of obtaining a credit report in connection with this application and will be accessible only to employees of PathStone Enterprise Center, Inc. who are processing this loan application.

Loan requests for new businesses must be accompanied by a detailed business plan. Loan requests for existing businesses should include a business plan summary describing the expansion for which financing is requested.

INFORMATION REQUIRED

Please provide the following information with your application form to prevent delays in the processing of your application. Please include a $25 application fee with your application form. PathStone will not process your application until the fee is received.

Please read the following certifications carefully and sign below. All company owners, officers, or partners must sign below. If you have any questions, call The Enterprise Center at PathStone at (585) 340-3300.

1. I certify that this company does not deny services, employment, or membership to persons based on political preference, race, religion, age, gender, sexual preference, handicap, or marital status.

2. I hereby certify and affirm by my signature below that the information supplied as part of this application is complete and current to the best of my knowledge. I further understand that intentional misrepresentation of facts may be the basis for a denial of credit.

3. I give PathStone permission to research the company and its principal(s) history, make credit checks, contact the company’s financial institution, and perform other related activities for reasonable evaluation of this proposal.

4. I certify that no principal who owns at least 50% of the voting interest of the company is delinquent more than 60 days under the terms of any (a) administrative order, (b) court order, or (c) repayment agreement that requires payment of child support.

5. I certify that ownership of the company is at least 51% by U.S. citizens or persons admitted to the U.S. for permanent residence.

6. I certify that The Enterprise Center at PathStone nor any of its principal officers (including immediate family) hold any legal or financial interest or influence in the Borrower; neither the Borrower nor any of its principal officers (including immediate family) hold any legal or financial interest in PathStone.

7. I certify that credit is not available elsewhere at reasonable rates and terms.
    
   Technical Assistance Disclaimer 

   PathStone may render technical assistance, directly or indirectly, to you based on information you provide, in connection with management systems, internal controls, marketing plans, business plans, financial projections, and compilations. Such assistance and all statements made in connection therewith are for your internal use only and are not to be used or communicated in any manner whatsoever to third parties without PathStone’s express written consent.

   PathStone is in no way responsible for your use of this information, and makes no warranties and representations in connection therewith except as expressly granted in writing. 

   You agree to indemnify and hold PathStone harmless in connection with the use or misuse of such information, documents, representations or writing.

   Thank you for your interest in The Enterprise Center at PathStone. Please fill out this application for the Small Business Loan Fund as completely as possible to enable PathStone to process your application promptly. Upon the receipt of a complete application, including all supporting documentation, and a check or money order for the $25 application fee, PathStone will process your application. A PathStone Loan Officer will contact you to discuss your application and, if necessary, request additional information. If you have any questions, please call PathStone at (585) 340-3300, TDD 800-545-1833 x210. You may write to The Enterprise Center at PathStone at 400 East Ave. Rochester, NY 14607 or visit our website at www.TheEnterpriseCenterInc.org.

PathStone is an equal opportunity provider. Complaints of discrimination should be sent to: USDA, Director, Office of Civil Rights, Washington, D.C. 20250-9410.