ࡱ> '` ' bjbj Z| &n n n n * * * t J4 )>>>>>yyyHJJJJJJ$%hnu* ߳ynn n >>n >* >HHh 6* >2 puvv]n< 0),---* yN Ǿ\#yyynndyyy) n n n n n n  Palm Tree Financial Co. LLC LOAN REQUEST FORM Applicant/ Company Name Phone Address State Zip Type of Business Established O W N E R S H I P O F A P P L I C A N T C O M P A N Y Name Title % Ownership ____________________________________________ ________________________________ _________________ **% Ownership must total 100%. A F F I L I A T E B U S I N E S S O W N E R S H I P ** Company Name Owner (Company or Individual) % Ownership** **20% ownership by company or individual must be listed. SBA LoanCapital InjectionEstimated Project Costs$Land Acquisition $New Building Construction$Building Improvements$Purchase Machinery & Equipment$Inventory$Working Capital$Debt Refinance$Other ___________________________________________________$Other ___________________________________________________$Total Loan Request$ BUSINESS PLAN We have identified below key items that we need to know about your business. If you have a more rn-depth business plan already completed, please submit it with The Application Booklet. Type of business including products and services offered. Complete history of business including start-up dates, analysis of industry to include customer base, trends, competition, and the seasonality of the business, if applicable. Also discuss the future plans for growth or expansion, if applicable. General location description to be comprised of all pertinent data including general area description, access, and visibility. General description of the actual business premise/primary collateral. This must include the total amount of square footage available and the amount that is occupied by your business. How will this loan benefit your business? SCHEDULE OF COLLATERAL Exhibit A ApplicantStreet AddressCity State Zip Code LIST ALL COLLATERAL TO BE USED AS SECURITY FOR THIS LOAN. Section I Real Estate Attach a copy of the deed(s) containing a full legal description of the land and show the location (Street address) and city where the deed(s) is recorded. Following the address below, give a brief description of the improvements, such as size, type of construction, use, number of stories, and present condition (use additional sheet if more space is required). LIST PARCELS OF REAL ESTATEAddressYear AcquiredOriginal CostMarket ValueAmount of LienName of LienholderDescription(s): BUSINESS DEBT SCHEDULE Company Name __________________________________________ Date ______________________________________ This schedule should include loans for contracts/notes payable and lines of credit, not accounts payable or accrued liabilities. CREDITOR Name/AddressORIGINAL DATEORIGINAL AMOUNTTERM or MATURITYPRESENT BALANCEINTEREST RATEMONTHLY PAYMENTCOLLATERAL OR SECURITYLOAN PURPOSE*TOTAL PRESENT BALANCE (Total must agree with balance shown on Interim Sheet)*Line of credit, equipment purchase, etc. CREDIT REFERENCE INFORMATION BUSINESS ACCOUNT Name Address Contact Phone # Fax # Account #  Name Address Contact Phone # Fax # Account #  NOTES PAYABLE CREDITORS Name Address Contact Phone # Fax # Account # Name Address Contact Phone # Fax # Account #  Name Address Contact Phone # Fax # Account # Name Address Contact Phone # Fax # Account # TRADE REFERENCESName Address Contact Phone # Fax # Account # Relationship Name Address Contact Phone # Fax # Account # Relationship Name Address Contact Phone # Fax # Account # Relationship Name Address Contact Phone # Fax # Account # Relationship  AUTHORIZATION TO RELEASE INFORMATION I/WE hereby authorize the release to ________________________________________________ of any and all information that _________________________________ may require at any time for any purpose related to our credit application! transaction with ___________________________________________. I/We further authorize _____________________________________ to release such information to any entity it deems necessary for any purpose related to our credit application/transaction with it. I/We hereby certify that the enclosed information (together with any attachments or exhibits) is valid and true, accurate and correct to the best of my/our knowledge. I/We hereby acknowledge that all loan approvals will be in writing and subject to the terms and conditions set forth in a commitment letter signed by an officer of _______________________________________ as well as to the related authorization from the SBA. Signature Date Signature Date PTFC PERSONAL FINANCIAL STATEMENT As of Complete this form for (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or more of voting stock of (4) any other person or entity providing a guaranty on the loan. Name Business PhoneResidence Address Residence honeCity, State & Zip CodeBusiness Name of Applicant/Borrower ASSETS (Omit Cents) LIABILITIES (Omit Cents) Cash on hands & in Banks $ Savings Accounts $ IRA or Other Retirement Account $ Accounts & Notes Receivable $ Life Insurance Cash Surrender Value Only $ (Complete in Section 8) Stocks and Bonds $ (Describe in Section 3) Real Estate $ (Describe in Section 4) Automobile Present Value $ Other Personal Property $ (Describe in Section 5) Other Assets $ (Describe in Section 5) TOTAL $ Accounts Payable $ Note Payable to Banks and Others $ (Describe in Section 2) Installment Account (Auto) $ Mo. Payments $____________ Installment Account (Other) $ Mo. Payments $____________ Loan on Life Insurance $ Mortgages on Real Estate $ (Describe in Section 4) Unpaid Taxes $ (Describe in Section 6) Other Liabilities $ (Describe in Section 7) Total Liabilities $ Net Worth $ TOTAL $  SECTION 1. Source of IncomeContingent LiabilitiesSalary $ Net Investment Income $ Real Estate Income $ Other Income (Describe below)* $ As Endorser or Co-Maker $ Legal Claims & Judgments $ Provision for Federal Income Tax $ Other Special Debt $ Description of Other Income in Section 1. Alimony or child support payments need not be disclosed in Other Income unless it is desired to have such payments counted toward total income.SECTION 2. Notes Payable to Bank and Others (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)Name and Address of Noteholder(s)Original BalanceCurrent BalancePayment AmountFrequency (Monthly, etc.)How Secured or Endorsed Type of Collateral SECTION 3. Stocks and Bonds (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)Number of Shares Name of Securities CostMarket Value Quotation/ExchangeDate of Quotation/Exchange Total ValueSECTION 4. Real Estate Owned (List each parcel separately. Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)Property AProperty BProperty CType of PropertyAddressDate PurchasedOriginal CostPresent Market ValueName & Address of Mortgage HolderMortgage Account NumberMortgage BalanceAmount of Payment per Month/YearStatus of MortgageSECTION 5. Other Personal Property and Other Assets (Describe, and if any is pledged as security, state name and address of lienholder, amount of lien, terms, or payment, and if delinquent, describe delinquency.)SECTION 6. Unpaid Taxes (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)SECTION 7. Other Liabilities (Describe in detail.)SECTION 8. Life Insurance held (Give face amount and cash surrender value of policies name of insurance company and beneficiaries.)I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001).Signature: Date: Social Security Number: Signature: Date: Social Security Number: Please note: The estimated average burden hours for the completion of this form is 1.5 hours per response. If you have questions or comments concerning this estimate or any other aspect of this form, please contact Chief, Administrative Branch, U.S. Small Business Administration, Washington, DC 20416, and Clearance Office, Paper Reduction Project (3245-0188). Office of Management and Budget, Washington, DC 20503. Form 4506 (Rev October 1994) Department of the Treasury Internal Revenue ServiceRequest for Copy Transcript Tax Form Please read instructions before completing form. Please type or print clearly. OMBB No. 1545-0429NOTE: Do not use this form to get tax account information. Instead, see instructions below.1 a. Name shown on tax form1b First social security number on tax form or employer identification number (See Instructions.) 2a If a joint return, spouses name shown on tax form2b Second social security number on tax form 3 Current name, address (including apt., room, or suite no.) city, state, and ZIP code (See instructions.)4 If copy of form or a tax return transcript is to be mailed to someone else, show the third partys name and address.5 If we cannot find a record of your tax form and you want the payment refunded to the third party, check here (6 If name in third partys records differs from line la above, show name here (See instructions.)7 Check only one box to show what you want:a ( Tax return transcript of Form 1040 series filed during the current calendar year and the 2 preceding calendar years. (See instructions.) (The transcript gives most lines from the original return and schedule[s].) There is no charge for a transcript request made before October 1,1995.b ( Copy of tax form and all attachments (including Form [s] W-2, schedules, or other forms). The charge if $14.00 for each period requested. Note: If these copies must be certified for count or administrative proceedings, see instruction and check here (c ( Copy of Form(s) W-2 only. There is no charge for this. See instructions for when Form W-2 is available Note. If the copy of Form W-2 is needed for its state information, check here (8 If this request is to meet a requirement of one of the following, check all boxes that apply. ( Small Business Administration ( Department of Education ( Department of Veterans Affairs ( Financial Institution9 Tax form number (Form 1040,1 040A, 941, etc.)11 Amount due for copy of tax form: a Cost for each period 14 b Number of tax periods requested on 0 c Total cost. Multiply line 11a by 11b 0 Full payment must accompany your request. Make check or money order payable to Internal Revenue Service10 Tax period(s) (yr. or period ended date). If more than 4, see instructions.PLEASETelephone number of requestorSIGNSignature. See instruction. If other than tax payer, attach authorization document.DateHEREBest time to callTitle (if line 1a above is a corporation, partnership, estate, or trust) Instructions A Change To Note: Form 4506 may be used to request a tax return transcript of the Form 1040 series filed during the current calendar year and the 2 preceding calendar years. There is no charge for a tax return transcript requested before October 1, 1995. You should receive it within 10 workdays after we receive your request. For more details, see the instructions for line 7a. Purpose of Form Use Form 4506 only to get a copy of a tax form, tax return transcript, verification of nonfiling, or a copy of Form W-2. But if you need a copy of your Form(s) W-2 for social security purposes only, do not use this form. Instead, contact your local Social Security Administration office. Do not use this form to request Forms 1099 or tax account information. If you need a copy of Form 1099, contact the payer. However, Form 1099 information is available by calling or visiting your local IRS office. Note: If you had your tax form filled in by a paid preparer, check first to see if you can get a copy for the preparer. This may save you both time and money. If you are requesting a copy of a tax form, please allow up to 60 days for delivery. However, if your request is for a tax return transcript, please allow 10 workdays after we receive your request. To avoid any delay, be sure to furnish all the information asked for on this form. You must allow 6 weeks after a tax form is filed before requesting a copy of it or a transcript. Tax Account Information Only If you need a statement of your tax account showing any later changes that you or the IRS made to the original return, you will need to request tax account information., Tax account information will list certain items from your return including any later changes. To request tax account information, do not complete this form. Instead, write or visit an IRS office or call the IRS toll-free number listed in your telephone directory. If you want your tax account information sent to a third party, complete Form 8821, Tax Information Authorization. You may get this form by calling 1 -800-829-3676. Line lb Enter your employer identification number only if your are requesting a copy of business tax form. Otherwise, enter the first social security number shown on the tax form. Line 2b If requesting a copy or transcript of a joint tax form, enter the second social security number shown on the tax form. Note: If you do not complete Line lb and, if applicable, Line 2b, there may be delay in processing your request. Line 3 For a tax return transcript, a copy of Form W-2 or for a verification of nonfiling, if your address on line 3 is different from the address shown on the last return you filed and you have not notified the IRS of a new address, either in writing or by filing Form 8822, Change of Address, you must attach either in writing or by filing Form 8822, Change of Address, you must attach either ) (continued on next page A copy of two pieces of identification that have your signature, or An original notarized statement affirming your identity. Line 4 If you have named someone else to receive the tax form or tax return transcript (such as a CPA, an enrolled agent, a scholarship board, or a mortgage lender), enter the name and address of the individual, If we cannot find a record of your tax form, we will notify the third party directly that we cannot fill the request. Line 6 Enter the name of the client, student, or applicant if it is different from the name shown on line 1 a. For example, the name on line 1 a may be the parent of a student applying for financial aid. In this case, you would enter the students name on line 6 so the scholarship board can associate the tax form or tax return transcript with their file. Line 7a If you are requesting a tax return transcript, check this box. Also, on line 9 enter the tax form number, on line 10 enter the tax period, and on line llc enter no charge. However, if you prefer, you may get a tax return transcript by calling or visiting your local IRS office. A tax return transcript shows most lines from the original return (including accompanying forms and schedules). It does not reflect any changes you or the IRS made to the original return. If you have changes to your tax return and want a statement of your tax account with the changes, see Tax Account Information Only on the front. A tax return transcript is available for any returns of the 1040 series (such as Form 1040, 1040A, or 1O4OEZ) filed during the current calendar year and the 2 preceding calendar years. In many cases, a tax return transcript will meet the requirement of any lending institution such as a financial institution, the Department of Education, or the Small Business Administration. It may also be used to verify that you did not claim any itemized deductions for a residence. Line 7b If you are requesting a certified copy of a tax form for court or administrative proceedings, check the box to the right of line 7b. It will take at least 60 days to process your request. Line 7c Check this box only if you want proof from the IRS that you did not file a return for the year. Also, on line 10 enter the tax period for which you are requesting verification of nonfiling, and on line llc, enter no charge. Line 7d If you need only a copy of your Form(s) W-2, check this box. Also, on line 9 enter Form(s) W-2 only, and on line llc enter no charge. Forms W-2 are available only from 1978 to the present. Form W-2 information is only available 18 months after it is submitted by your employer. But you can get this information earlier if you request a copy of your tax return and all attachments. See line 7b. If you are requesting a copy of your spouses Form W-2, you must have your spouses signature on the request. If you lost your Form W-2 or have not received it by the time you are ready to prepare your tax return, contact your employer. Line 10 Enter the year(s) of the tax form or tax return transcript you are requesting. For fiscal-year filers or requests for quarterly tax forms, enter the date the period ended; for example, 3/31/93, 6/30/93, etc. If you need more than four different tax periods, use additional Forms 4506. Tax forms filed 6 or more years ago may not be available for making copies. However, tax account information is generally still available for these periods. Line 11c Write your social security number or Federal employer identification number and Form 4506 Request on your check or money order. If we cannot fill your request, we will refund your payment. Signature Requests for copies of tax forms or tax return transcripts to be sent to a third party must be signed by the person whose name is shown on line 1 a or by a person authorized to receive the requested information. Copies of tax forms or tax return transcripts for a jointly filed return may be furnished to either the husband or the wife. Only one signature is required. Sign Form 4506 exactly as your name appeared on the original tax form. If you changed your name, also sign your current name. For a corporation, the signature of the president of the corporation, or any principal officer and the secretary, or the principal officer and another officer are generally required. For more details on who may obtain tax information on corporations, partnerships, estates, and trusts, see Internal Revenue Code section 6103. If you are not the taxpayer shown on line ha, you must attach your authorization to receive a copy of the requested tax form or tax return transcript. You may attach a copy of the authorization document if the original has already been filed with the IRS. This will generally be a power of attorney (Form 2848), or other authorization, such as Form 8821, or evidence of entitlement (for Title 11 Bankruptcy or Receivership Proceedings). If the taxpayer is deceased, you must send Letters Testamentary or other evidence to establish that you are authorized to act for the taxpayers estate. Note: Form 4506 must be received by the IRS within 60 days after the date you signed and dated the request. Were to File Mail Form 4506 with the correct total payment attached, if required, to the Internal Revenue Service Center for the place where you lived when the requested tax form was filed. Note: You must use a separate form for each service center from which you are requesting a copy of your tax form or tax return transcript. If you lived in:Use this addressNew Jersey, New York New York City and Counties of Nassau, Rockland, Suffolk, and Westchester)1040 Waverly Ave. Photocopy Unit Stop 532 Holtsville, NY 11742New York (all other counties), Connecticut Maine, Massachusetts, New Hampshire, Rhode island, VermontStop 679 Andover, MA 01810 Florida, Georgia South Carolina4800 Butord Hwy. Photocopy Unit Stop 91 Doraville, GA 30362Indiana, Kentucky, Michigan, Ohio, West VirginiaP.O. ox 145500 Photocopy Unit Stop 524 Cincinnati. OH 45250 Kansas, New Mexico, Oklahoma, Texas3651 South lnterregional Hwy. Photocopy Unit Stop 6716 Austin, TX 73301Alaska, Arizona, uaiitornia, lcounties of Alpine, Amador. Butte, Calaveras, Colusa, Contra Costa, Dei Norte, El Dorado, Gienn, Humboldt, Lake, Lasses, Mann, Mendocino, Modoc, Napa, Nevada, Piacer, Plumas, Sacramento, San Joaquin, Shasta, Sierra, Siskiyou, Soiano, Sonoma, Sutter, Tehama, Trinity, Yolo, and Yuba), Coiorado, idaho. Montana, Nebraska, Nevada, North Dakota. Oregon, South Dakota, Utah, Washington. Wyoming RO. Box 9953 Photocopy Unit Stop 6734 Odgen, UT 84409 California lall other counties), Hawaii5045 E. Butler Avenue Photocopy Unit Stop 52180 Fresno, CA 93888Illinois, Iowa, Minnesota, Missouri, Wisconsin2306 E. Bannister Road Photocopy Unit Stop 57A Kansas City, MO 64999Alabama, Arkansas, Louisiana. Mississippi. North Carolina, Tennessee RO. Box 30309 Photocopy Unit Stop 46 Memphis, TN 38130Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, a foreign country, orA.P.O. or F.P.O. address 11601 Roosevelt Blvd. Photocopy Unit OP 536 Philadelphia, PA 19255 Privacy Act and Paperwork Reduction Act Notice We ask for the information on this form to establish your right to gain access to your tax form or transcript under the Internal Revenue Code, including sections 6103 and 6109. We need it to gain access to your tax form or transcript in our files and properly respond to your request. If you do not furnish the information, we will not be able to fill your request. We may give the information to the Department of Justice or other appropriate law enforcement official, as provided by law. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is: Note: Form 4506 must be received by the IRS within 60 days after the date you signed and dated the request. Recordkeeping 13 min. Learning about the law or the form 7 min. Preparing the form 25 min. Copying, assembling, and sending the form to the IRS 17 min. If you have comments concerning the accuracy of these time estimates or suggestions for making this form more simple, we would be happy to hear from you. You can write to both the Internal Revenue Service, Attention: Reports Clearance Officer, PC:FP, Washington, DC 20224; and the Office of Management and Budget, Paperwork Reduction Project (1545-0429), Washington, DC 20503. DO NOT send this form to either of these offices. Instead, see Where To File on this page. United States Of America SMALL BUSINESS ADMINISTRATION STATEMENT OF PERSONAL HISTORYPLEASE READ CAREFULLY PRINT OR TYPE Each member of the small business concern or the development company requesting assistance must submit this form in TRIPLICATE for filing with the SBA application. This form must be filled out and submitted by: 1. If a sole proprietorship by the proprietor. 2. If a partnership by each member. 3. If a corporation or a development company, by each officer, director and additionally by each holder of 20% of more of the voting stock. 4. Any other person including a hired manager, who has authority to speak for and commit the borrower in the management of the business.Name and Address of Applicant (Firm Name (Street, City, State and ZIP Code)SBA District/Disaster Area OfficeAmount Applied for: $ Loan Case No.1. Personal State of: (State name in full, if no middle name, state (NMN), or if initial only, indicate initial. List all former names used, and dates each name was used. Use separate sheet if necessary. First Middle Last9. Name and address of participating bank 2. Date of Birth: (Month, day and year)3. Place of Birth: (City & State or Foreign Country)4. Give the percentage of ownership or stock owned or to be owned in the small business or the Development Company: 0/%Social Security NumberU.S. Citizen? ( Yes ( No if no, give alien registration number:5. Present residence address: From: To: Address Home Telephone No. (Include A/C): Business Telephone No. (Include A/C): Immediate past residence address: From: To: Address BE SURE TO ANSWER THE NEXT 3 QUESTIONS CORRECTLY BECAUSE THEY ARE IMPORTANT. THE FACT THAT YOU HAVE AN ARREST OR CONVICTION RECORD WILL NOT NECESSARILY DISQUALIFY YOU. BUT AN INCORRECT ANSWER WILL PROBABLY CAUSE YOUR APPLICATION TO BE TURNED DOWN. IF YOU ANSWER YES TO 6,7 OR 8, FURNISH DETAILS IN A SEPARATE EXHIBIT. INCLUDE DATES; LOCATION; FINES, SENTENCES, ETC.; WHETHER MISDEMEANOR OR FELONY; DATES OF PAROLE/PROBATION; UNPAID FINES OR PENALTIES; NAMES UNDER WHICH CHARGED; AND ANY OTHER PERTINENT INFORMATION.6. Are you presently under indictment, on parole, or probation? ( Yes ( No (If yes, indicate date parole or probation is to expire.)7. Have you ever been charged with or arrested for any criminal offense other than a minor motor vehicle violation? Include offenses which have been dismissed, ( Yes ( No discharged, or nolle prosequl. (All arrests and charges must be disclosed and explained on an attached sheet.)8. Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation, for any ( Yes ( No criminal offense other than a minor motor vehicle violation?( Fingerprints Waived _________________________ Date Approving Authority ( Fingerprints Required _________________________ Date Sent to FBI ______________________ Date Approving Authority( Cleared for Processing _________________________ Date Approving Authority ( Request a Character Evaluation _________________________ Date Approving AuthorityThe information on this form will be used in connect with an investigation of your character. Any information you wish to submit, that you feel will expedite this investigation should be set forth.CAUTION: Knowingly making a false statement on this form is a violation Federal law and could result in criminal prosecution, significant civil penalties, and a denial of your loan. A false statement is punishable under 18 USC 1001 by imprisonment of not more than five years and/or a fine of not more than $10,000; under 15 USC 645 by imprisonment of not more than two years and/or a fine of not more than $5, 000; and, if submitted by Federal insure institution under 18 USC 1014 b not more than twenty years and/or a fine of not more than $1 000 000.Signature Title DateIt is against SBAs policy to provide assistance to persons not of good character and therefore consideration is given to the qualities and personality traits of a person, favorable and unfavorable relating thereto, including behavior, integrity, candor and disposition toward criminal actions. It is also against SBAs policy to provide assistance not in the best interests of the United States, for example, if there is reason to believe that the effect of such assistance will be to encourage or support, directly or indirectly, activities inimical to the Security of the United States. Anyone concerned with the collection of this information, as to its voluntariness, disclosure of routine uses may contact the FOIA Office, 409 3rd St. S.W., and a copy of 9 Agency Collection of Information form SOP 4004 will be provided. SBA FORM 912 (12-93) SOP 9020 USE 5-87 EDITION UNTIL EXHAUSTED Please Note: The estimated burden hours for completion of this form is 15 minutes per response. If you have any questions or comments concerning this estimate or any other aspect of this information collection please contact, Chief Administrative Information Branch, U.S. Small Administration 409 Third Street, SW. Washington, D.C. 20416 or Gary Waxman, Clearance Officer, Paperwork Reduction Project (3245-0178); Office of Management and Budget, Washington, DC 20503. MANAGEMENT RESUME Please fill in all spaces. If an item is not applicable, please indicate as such. You may include additional relevant information on a separate exhibit. SIGN/DATE where indicated. P E R S O N A L I N F O R M A T I O N Name SS # Date of Birth Place of Birth Residence Telephone Business Telephone Residence Address From To Present Date Previous Address Spouses Name SS # Are you employed by the U.S. Government? ( Yes ( No Agency/Position Are you a U.S. Citizen? ( Yes ( No If no, give alien registration E D U C A T I 0 N College/Technical Training Name/Location Dates Attended Major Degree/Certificate M I L I T A R Y S E R V I C E B A C K G R O U N D Branch of Service Dates of Service W O R K E X P E R I E N C E List chronologically beginning with present employment. Company Name/Location From To Title Duties Company Name/Location From To Title Duties Company Name/Location From To Title Duties Signature Date PRO FORMA INCOME STATEMENT Please attach a narrative explaining how you developed these projections. Business Entity: First Year Second Year Projections Projections Dollar Estimate Dollar Estimate Gross Receipts $ $ Merchandise Cost $ $ GROSS PROFIT $ $ EXPENSES: Officers Salaries (only if Corp.) $ $ Employees Wages $ $ Accounting and Legal Fees $ $ Advertising $ $ Rent $ $ Depreciation $ $ Supplies $ $ Utilities $ $ Telephone $ $ Interest $ $ Repairs $ $ Taxes $ $ Insurance $ $ Bad Debts $ $ Miscellaneous (Postage, etc.) Itemize if miscellaneous is large Other (Explain) $ $ ___________________________________________ ___________________________________________ TOTAL EXPENSES $ $ NET PROFIT BEFORE TAXES $ $ LESS: INCOME TAXES $ $ NET PROFIT AFTER TAXES $ $ LESS WITHDRAWALS $ $ (Only if Proprietorship or Partnership) NET PROFIT REMAINING FOR PAYMENTS ON LOAN $ $ I certify the foregoing data fairly represents the potential annual earnings to the best of my knowledge. Signature Title Date Commercial Lending Simplified Business, Industry & Commercial Real Estate Financing From $500,000.00 to $500,000,000.00 SBA, USDA RDA B&I, CONVENTIONAL, CONDUIT, STRUCTURED, MEZZANINE & GAP EQUITY, ASSET BASED LOAN PROGRAMS & SBICs VENTURE CAPITAL Competitive Rates and Flexible, Customized Terms t Up to 90% Financing t Up to 25 Year Terms Startups, Acquisitions & Mergers, Leverage Buyouts, Refinance, Growth Financing, Renovations & Management Buyouts  Competitive Rates and Flexible, Customized Terms Call us today! Tel: (305) 984-1911, Fax: (305) 513-5199 E-Mail: david@inthepalmtree.com Website: www.inthepalmtree.com Palm Tree Financial Co. 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