EFTA00603331.pdf

OMB Approval No. 3245-0201 Expiration Date: 11/3012012 FEE DISCLOSURE FORM AND COMPENSATION AGREEMENT For Agent Services In Connection With an SBA 7(a) Loan Purpose of this form: Section 13 of the Small Business Act (15 USC §642) requires that a small business SBA loan applicant ("Applicant") identify the names of persons engaged by or on behalf of the Applicant for the purpose of expediting the application and the fees paid or to be paid to any such person. 13 C.F.R., Part 103.5 requires any Agent to execute and provide to SBA a compensation agreement ("Agreement") showing the compensation charged for services rendered or to be rendered to the Applicant or lender in any matter involving "Agent" compensationnder loan packager, refernal agent, accountant attomem,consultant. pi any other other party mat receives troth representing an Applicant in connection With an sisn man. k C.F.R. Part 103 and sections 120.221, and 120.222 contain the rules governing compensation of Agents in connection with a 7(a) loan. These rules may be found at www.sba.govflibrary.) A 7(a) participating lender ("Lender") may charge an Applicant reasonable fees for packaging services that are customary for similar lenders in the geographic area where the loan is being made. The Lender must advise the Applicant in writing that the Applicant is not required to obtain or pay for these services if they are unwanted. The Lender cannot charge an Applicant any commitment, bonus, broker, commission, referral or similar fee. If an Applicant chooses to employ an Agent to represent the Applicant, compensation an Agent or the Lender charges to and that is paid by the Applicant must bear a necessary and reasonable relationship to the services fklitiarkfilryrfl&ntreifisesCan ntiraellgeneinaPAW ItWa tnniclestasiarrriocvonifielciliggd4lartaramapplicationtor are is figtrrnt on terIp bcriigaBnt vkeldee§12nisl A aeems cancel the amount of compensation unreasonable, the Agent or the Lender must reduce the compensation charged to an reasonable at nalleirrnallingin3N(ENITig o c. i refundt. ti; gragliglits fir Abiginsf anof lgoaulEriltjPetsdoefetiges reasonable, amount SBA deems reasonable. Violation.bv an Agent or the Lender Of any of these rules may result in SBA's suspension or revocation ot the pnvitege ot conducting business with SBA. The following are not considered Agents for purposes of this Agreement and, therefore, are not required to complete this Agreement: I) Applicant's accountant for the preparation of financial statements required by the Applicant in the normal course of business and not related to the loan application; 2) a state-certified or state- ISejigedpfgel sreStigigirgnW IHI Wagr2ThPerdi giv 221pppro o lgnrevghheAtA Lakkituvidpa ‘Ivegger performs a business valuation; 5) an environmental professional employed by the lender to conduct an .vnairilinerni(iffilot sta Tot. cifnu fight,eakia cesipsegissneivah witth wim loan closing do not need to be reported in this Agreement. Instructions on completion of this form : This form must be completed in connection with a loan application if I) the Applicant has paid (or will be paying) compensation to an Agent or the Lender 2) if the Lender has (or will be paying) referral fee. There must be a completed Agreement for each Agent compensated by the Applicant. If the certifications are,wade by a legal entint other than an individual (pa, corporationdimited liability company), execution ot the certification mustte me legal entity s name toy a duly auttfonzea othcer or other representative of the entity; if by a partnership, execution of the certification must be in the partnership's name by a general partner. If the total compensation exceeds $2,500, the compensation must be itemized. PLEASE NOTE: The estimated burden for completion of this Form 159 is 5 minutes per response. You arc not required to respond to this information collection unless it displays a currently valid OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration. Chief. Administrative Information Branch. Washington, D.C. 20416, and Desk Officer for SBA, Office of Management and Budget. New Exec. Office Building, Room 10202. Washington, D. C. 20503. PLEASE DO NOT SEND FORMS TO OMB. SBA Form 159 (7a) (8-09) Ref SOP 50 10 and 70 50. Previous editions obsolete. I EFTA00603331  Loan applicant name: Loan applicant business name (if any): re,.t and Certipestityraigning this Agreement, the undersigned Agent agrees that it has not a Vector or indirectly Charge or receive any payment in connection with the application for or making of the SBA loan except for services actually performed on behalf of Applicant and identified in this Agreement. The undersigned Agent cedifies that the information provided in this.Aereement accurately descbes the of services it has providecrto the Applicant and that the compensation described in this Agreemertt is me only compensation teat has been charged to or received from the Applicant or that will be charged to the Applicant as an Agent for services covered by this Agreement. WARNING: False certifications can result in criminal prosecution under 18 U.S.C. §1001 and other penalties provided under law. Type of agent: O Independent loan O Lender compensated dd aCeigitiEgooyegelitrat O Other (describe): packager by applicant for loan packaging services applicant Type of services agent provided to applicant: O Loan packaging O Financial statements sakekliafli§fferral O Other (describe): specifically for the application applicant Total compensation charged to applicant : $ lithe amount exceeds $2,500: For the entire compensation charged, attach a separate schedule itemizing 1) the services performed; and 2) the hourly rate and the number of hours billed for that service. Agent Name and Signature: BY —(Signature of agent) (Date) (Name of agent — please print) (Business name of agent — please print) (Business address of agent including zip code) (Business address cont.) Applicant's Certification: The undersigned Applicant certifies to SBA that the above representations and amounts are the only amounts paid by the Applicant in connection with the services covered by the Agreement and are satisfactory to the Applicant. The Applicant further certifies that a compensation agreement (Form 159) has been executed for all Agents, as defined above, involved with this loan. WARNING: False certifications can result in criminal prosecution under 18 U.S.C. § 1001 and other penalties provided under law. By: (Applicant's Name) (Signature of authorized representative) (Date) (Name of authorized representative - please print) SBA Form 159 (7a) (8-09) Ref SOP 50 10 and 70 50. Previous editions obsolete. 2 EFTA00603332 Lender's Certification: The undersigned 7(a) participating lender certifies that the representations of services rendered to tT81 211`kfirodialasolvtagethiti ihgrAngeggtrat Mae& g si setagicIA reTpigsgeedsOrv,grgles8 agVeciealf of the Applicant other than disclosed above or in another executed compensation agreement (Form 159). The undersigned further certifies that any referral fees described below are the only referral fees paid by the lender to a referral agent in connection with this loan, and were not charged directly or indirectly to the Applicant. WARNING: False certifications can result in criminal prosecution under 18 U.S.0 § 1001 and other penalties provided under law. (Name of referral agent — please print) (7(a) lender name) (Business name of agent — please print) By: (Signature of authorized lender representative) (Date) (Business address of agent including zip code) (Name of authorized lender representative - please print) (Business address cont.) Referral fee paid, if any: $ SBA Form 159 (7a) (8-09) Ref SOP 50 10 and 70 50. Previous editions obsolete. 3 EFTA00603333