La Crosse County Revolving Loan Fund Application - Mississippi River Regional Planning Commission

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Date of Submission:

04/26/2024

Business Information

*Business Name:

*Date Established:

MM/DD/YYYY

*Type of Organization:

*Telephone Number:

*Business Address:

*City:

*State:

*ZIP Code:

County:

La Crosse

*Federal ID Number:

*State ID Number:

Contact Information

*Name:

*Telephone Number:

*Email Address:

*Verify Email:

To help ensure your email address is correct, please enter it a second time.

Business OwnershipPlease include owner(s), officer(s), & shareholder(s) who own 20% or more shares of the company. *

Owner #1:

*Name:

*% Ownership:

*Telephone Number:

Email Address:

*Home Address:

*City:

*State:

*ZIP Code:

- Remove this Owner

+ Add Another Owner

* Personal financial statements and tax returns are required for those with 20% or greater ownership interest.

Bank Information

*Bank Name:

*Contact Person:

*Telephone Number:

Email Address:

*Bank Address:

*City:

*State:

*ZIP Code:

Attorney Information

*Business Name:

*Contact Person:

*Telephone Number:

Email Address:

*Attorney Address:

*City:

*State:

*ZIP Code:

Accountant Information

*Business Name:

*Contact Person:

*Telephone Number:

Email Address:

*Accountant Address:

*City:

*State:

*ZIP Code:

Current and Projected Employment

Loan criteria for this loan require a minimum of one job be created or retained for every $10,000 to $15,000 of RLF financing.

Professional / Manager / Technical Jobs

*Existing: # Full-Time:

*Existing: # Part-Time:

*First Year: # Full-Time:

*First Year: # Part-Time:

*Second Year: # Full-Time:

*Second Year: # Part-Time:

Skilled Jobs

*Existing: # Full-Time:

*Existing: # Part-Time:

*First Year: # Full-Time:

*First Year: # Part-Time:

*Second Year: # Full-Time:

*Second Year: # Part-Time:

Unskilled / Semi-Skilled Jobs

*Existing: # Full-Time:

*Existing: # Part-Time:

*First Year: # Full-Time:

*First Year: # Part-Time:

*Second Year: # Full-Time:

*Second Year: # Part-Time:

Anticipated Sources & Uses of Funds

Loan Criteria

$2 of private or other financing to every $1 of RLF financing is required.
Money from this loan fund is always in conjunction with a sponsoring senior lender or other investment capital. To apply for a RLF loan a business must also secure private financing. The sponsoring senior lender will be invited to appear at the County Loan Board meeting to answer questions concerning the loan and about the need of an inter-creditor agreement.
Each project will require a minimum of 10% equity.
Real estate, working capital, and equipment all are eligible financing uses. Adequate collateral and security requirements will be sought on all RLF loans. The RLF may take a subordinated position behind a senior lender.

In addition to the MRRPC Loan, Bank Loan, and existing Equity, will you have additional sources of funds you will be using?

*# of Other Sources:

No other sources

1 additional source

2 additional sources

*Source #1 Name:

*Source #2 Name:

Use: Acquire Land

*$ from RLF:

*$ from Bank:

*$ from Equity:

*$ from —:

Use: Acquire Building

*$ from RLF:

*$ from Bank:

*$ from Equity:

*$ from —:

Use: Improve/Renovate Building

*$ from RLF:

*$ from Bank:

*$ from Equity:

*$ from —:

Use: Purchase Equipment/Machinery

*$ from RLF:

*$ from Bank:

*$ from Equity:

*$ from —:

Use: Inventory

*$ from RLF:

*$ from Bank:

*$ from Equity:

*$ from —:

Use: Working Capital

*$ from RLF:

*$ from Bank:

*$ from Equity:

*$ from —:

Use: Other #1

Use Funds For:

$ from RLF:

$ from Bank:

$ from Equity:

$ from —:

Use: Other #2

Use Funds For:

$ from RLF:

$ from Bank:

$ from Equity:

$ from —:

Use: Other #3

Use Funds For:

$ from RLF:

$ from Bank:

$ from Equity:

$ from —:

Project SummaryLoan or Equity Amount

RLF:

Bank:

Equity:

—:

Loan Term (Years)

RLF:

Bank:

Equity:

—:

Loan Interest Rate

RLF:

Bank:

Equity:

—:

Annual Debt Service

RLF:

Bank:

Equity:

—:

Type of Collateral

RLF:

Bank:

Equity:

—:

Security Position

RLF:

Bank:

Equity:

—:

Type of Guarantee

RLF:

Bank:

Equity:

—:

Required Exhibits

The following exhibits must be completed where applicable and included as part of your application. After you submit this first page, you will receive an email with the list of documents needed and a link to attach those exhibits at a later time. You will also be taken to a form to begin uploading any exhibits you may have already prepared.

The Mississippi River Regional Planning Commission reserves the right to request additional information above and beyond this list.

Business Plan (see business plan outline below, take note of the financial data required in part h ).
Signed personal financial statements dated as part of application for any person who owns 20% or more interest in the business.
Key person insurance or property insurance, which may be available or has been obtained to secure the loan.
Federal tax returns filed by the business for last three years.
Provide evidence business is current on federal quarterly payroll withholding. (Federal Form 941)
Provide evidence business is current on State payroll withholding. (Wisconsin Form W-6, provide other state forms if applicable)
Provide evidence business is current on payment of unemployment taxes. (Letter from accountant or attorney)
Provide evidence business is current on payment of federal income taxes. (Letter from accountant or attorney)
Provide evidence business is current on payment of state income taxes. (Letter from accountant or attorney)
Provide evidence business is current on payment of real estate taxes. (Letter from accountant or attorney)
Provide copy of business’s articles of incorporation.
Provide copy of business’s bylaws.
Provide evidence that business’s corporate minute book exists.
Commitment letter from the participating lender stating its commitment on the amount and terms of the financing it will provide for the project.
Statement from the participating lender that the RLF loan will not be substituting for commercial lending.
Statement from the business indicating its job commitment and agreement that failure to meet its job commitment may result in an RLF loan interest rate increase, job penalty payment or complete recall of the County loan.
A statement from the business certifying that it will not relocate out of La Crosse County during the term of the RLF loan and that in the event of relocation outside of the County it will immediately prepay the RLF loan. In addition, the applicant must sign a certificate of non-relocation.

Business Plan Outline:

Executive Summary should include: (1) Name and location of business; (2) Brief discussion of product, market and competition; (3) Expertise of management team; (4) Summary of financial projections; (5) Amount of financial assistance requested and proposed purpose; and (6) Business goals and reasons for undertaking the project.
Description of Company: (1) Date and state of incorporation or formation, (2) History of company, (3) Background of the principals and their roles.
Market Analysis: (1) Description of current industry and industry trends, (2) Description of the total market and its participants and (3) Discussion of the target market, your competition, and list of the names of your top four competitors.
Description of the Product or Service: (1) List of patents, copyrights, licenses or proprietary interests; (2) Discussion of technical and legal considerations; (3) Comparisons to competitors’ products or services and (4) Description of current and future research and development.
Marketing Strategy: (1) Overall strategy; pricing policy and sale terms; (2) Method of selling, distributing and servicing; (3) Current and estimated sales and market share and (4) Advertising, public relations, and promotion.
Management Plan: (1) Form of business organization, (2) composition of board of directors, officers, organization chart and responsibilities and (3) Resumes of key personnel and listing by key advisors.
Operating Plan: (1) Schedule of upcoming work and key completion dates for next two years, (2) Planned facilities or capital improvements for next three years and (3) Staffing plan.
Financial Data: (1) Describe the amounts, sources and uses of all project funding, (2) Provide balance sheet, income statement and cash flow statement for the past three years, (3) Provide current (90 days or less) interim balance sheet, income statement and cash flow statement, (4) Provide pro-forma cash flow projections including the proposed financing for two years, (5) Provide projected balance sheets and income statements including the proposed financing for two years (6) Describe all the assumptions behind the financial projections.

Note: It is highly recommended and preferred that all Financial Data described in “h.” above be prepared by an independent certified public accountant, if not please provide your reason for not using this service as part of “h”.

Questions

Is the a new start-up business?

*Answer:

Yes

Details:

You will be asked to provide the details as a separate exhibit showing evidence it is registered with the Wisconsin Department of Revenue (My Tax Account) and it is registered with the Federal Tax Payment System (FTPS).

Has the business, any officer, subsidiary or affiliate of your company been involved in any bankruptcy or insolvency proceedings in the last 36 months?

*Answer:

Yes

Details:

You will be asked to provide the details as a separate exhibit.

Has the business, any officer, subsidiary or affiliate of your company been involved in any lawsuits in the past 36 months?

*Answer:

Yes

Details:

You will be asked to provide the details as a separate exhibit.

Digital Acceptance & Signature

BY SIGNING BELOW, THE APPLICANT

Certifies that to the best of its knowledge and belief, the information being submitted to the La Crosse County Economic Development Fund and its agent is true and correct.
Certifies that it is in compliance with all laws, regulations, ordinances, and orders of public authorities applicable to it.
Certifies that it is in compliance with and current on federal payroll withholding, state payroll withholding, payment of unemployment taxes, federal income taxes, state income taxes and real estate taxes.
Certifies that it is not in default under the terms and conditions of any grant or loan agreements, leases, or financing arrangements with any other creditor.
Certifies that the La Crosse County Business Fund Inc. or its agent is authorized to obtain a credit check on any principal or business associated with this application for the purposes of determining credit worthiness.
Agrees to reimburse the La Crosse County Business Fund Inc. its agent for any reasonable expenses made in connection with this loan request, including, but not limited to, title work, legal fees, appraisals, recording /filing fees etc.
Certifies that it has disclosed and will continue to disclose any occurrence or event that could have an adverse material impact on the project described in this application. Adverse material impact includes but is not limited to lawsuits, criminal or civil actions, bankruptcy proceedings, regulatory intervention or adequate capital to complete the project.
Agrees that in the event credit is extended it will complete a direct payment authorization form allowing payments to be electronically debited by automatic clearing-house (ACH) and deposited into the appropriate La Crosse County Economic Development Fund Account.

*Full Name:

*Title:

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*Signature:

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Signature:

Second Signature?:

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*Full Name:

*Title:

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*Signature:

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