CalCAP for Small Business Program Loan Enrollment Application;

_______________________________________________________________________

CalCAP for Small Business Program

Loan Enrollment Application

California Pollution Control Financing Authority (CPCFA) Mailing Address: P.O. Box 942809

California Capital Access Program (CalCAP) Sacramento, CA 94209-0001

CalCAP@treasurer.ca.gov Fax (916) 589-2805

(916) 654-6510

CalCAP

Use

Loan #

Only

Date

Received

Lender Information

Participating Lender:

Lender CalCAP ID#:

Lender Contact Name:

Lender Contact Phone Number:

Lender Contact Email:

Borrower Information

Borrower Name:

Borrower’s Business Name:

Business EIN/Tax ID (Do not include Social Security Number):

Page 1 of 5 Revised 05.10.2024

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CalCAP for Small Business Program Loan Enrollment Application

Form of Business Organization (Corporation, Sole-Proprietorship, Limited Liability Company etc.):

Address:

City:

County:

Zip:

Type of Business/Activities:

Year the businesses was incorporated or opened:

Annual Revenues Last Fiscal Year ($):

Average Annual Revenue Last 3 Years ($):

Number of Employees:

Number of Full Time Equivalents:

Number of Jobs Created:

Number of Jobs Retained:

Is the business located in a Severely Affected Community (SAC)? (Yes or No):

If yes, provide the reason (City, Unincorporated, County if City not listed, or Other):

Page 2 of 5 Revised 05.10.2024

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CalCAP for Small Business Program Loan Enrollment Application

Will loan monies be used at the above address? (Yes or No):

If no, provide the address where loan monies will be used

Address:

City:

County:

Zip:

6-Digit NAICS Code (https://www.census.gov/naics/):

11-Digit Census Tract # (https://geomap.ffiec.gov/ffiecgeomap/):

Purpose of Loan:

Is business minority owned? (Yes, No, or Decline to Answer):

Is business woman owned? (Yes, No, or Decline to Answer):

Is business veteran owned? (Yes, No, or Decline to Answer):

Loan Information

Is this loan enrolled in any other government guarantee program? (Yes or No):

If yes, name the program:

Page 3 of 5 Revised 05.10.2024

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CalCAP for Small Business Program Loan Enrollment Application

What percent of loan is enrolled in another program? (%):

What percentage of loan is being enrolled in CalCAP? (%):

Lender Loan Number:

Type of Loan (Line of Credit or Term Loan):

Total Loan Amount:

Loan Amount Enrolled in CalCAP:

Date of First Disbursement (Date of Loan):

Maturity Date:

Interest Rate (%):

Is Interest Rate Fixed or Variable?:

Loan APR (%):

Is the loan secured? (Yes or No):

Is this loan a restructure of a prior CalCAP loan? (Yes or No):

If yes, provide the CalCAP Loan #:

Remaining balance on loan being restructured ($):

Page 4 of 5 Revised 05.10.2024

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CalCAP for Small Business Program Loan Enrollment Application

Amount of increase requested ($):

Borrower Fee ($):

Borrower Percentage (%):

Lender Fee ($):

Lender Percentage (%):

Total Loan Origination Charges ($) *This does not include Program Fees:

When complete, please send to: CalCAP@treasurer.ca.gov

Page 5 of 5 Revised 05.10.2024