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MON VALLEY ALLIANCE FOUNDATIONMICRO-LOAN / MICRO-GRANTPROGRAMPERSONAL GUARANTYSUPPLEMENTAL APPLICATIONINSTRUCTIONS: In order to be eligible for the assistance requested in the Micro-Loan / MicroGrant Application and this Supplemental Application, ALL INFORMATION REQUESTED mustbe completed, or a written explanation as to why requested information is not available or providedmust be attached to this Supplemental Application. If insufficient space is provided on theapplication for any portion, please attach a separate page to the application. All completedapplications should be submitted to:Mon Valley Alliance FoundationAttn: Micro-Loan / Micro-Grant ProgramP.O. Box 145Charleroi, PA 15022The Application must be in conformance will all requirements of the Program Policies andProcedures, a copy of which is available at www.monvalleyalliance.org/services/financing or bycontacting the Mon Valley Alliance Foundation at (724) 565-5636. All eligibility guidelines,program requirements, information concerning interest rates, evaluation standards, and conditionsof repayment are contained in the Program Policies and Procedures.All Applications will be evaluated as a request for loan funding at an interest rate equal to thePrime Interest Rate minus 1.5% (Prime - 1.5%) at the time of the offering of a loan estimate to theapplicant, unless otherwise recommended for a lower interest rate or grant award by the MicroLoan / Micro-Grant Committee and approved by the MVAF Board of Directors.For assistance in completing this Application, or for general questions concerning the Program,please contact the Mon Valley Alliance Foundation at (724) 565-5636.No applicant or loan will be denied based upon race, religion, ethnicity, age, sex, sexualorientation, national origin, marital status, pregnancy, disability, an applicant’s receipt ofincome from any public assistance agency, or any applicant’s exercise of any and all rightsdefined and provided by the Consumer Credit Protection Act.
MON VALLEY ALLIANCE FOUNDATION MICRO-LOAN /MICRO-GRANT PROGRAMPERSONAL GUARANTY SUPPLEMENTAL APPLICATIONPart I: Applicant InformationNameAddressHome TelephoneMobile TelephoneWork TelephoneEmailDATE OF BIRTH:SOCIAL SECURITY NO.MARITAL STATUS:DRIVER LICENSE NO.:EMPLOYMENT INFORMATION:Employer NamePosition/TitleAddressDate of EmployName of Direct SupervisorTelephoneCURRENT MONTHLY GROSS SALARY/WAGES:DO YOU RECEIVE ANY OTHER INCOME FROM ANY OTHER SOURCE? Yes NoIf yes, please describe from whom or where the income is received, the monthly amountof the income, and whether you expect the income to be available during the next sevenseven (7) years.
Part II: Asset InformationAUTOMOBILES:Automobile #1 Make, Model, and YearValueAutomobile #2 Make, Model, and YearValueDate OccupiedValueREAL ESTATE:AddressBANK ACCOUNTS:Name of Financial InstitutionType of Account (Checking, Savings, Etc.)ValueName of Financial InstitutionType of Account (Checking, Savings, Etc.)ValueOTHER ASSETS:Describe Asset #1 (including location if applicable)ValueDescribe Asset #2 (including location if applicable)ValuePart III: Liability InformationPlease list any real estate liability, such a rent or a mortgage payment, first. If thereal estate liability constitutes rent, please type RENT in the current balance entMaturityDateCurrentStatusSecuredLoan?
Part IV: Miscellaneous InformationARE YOU A U.S. CITIZEN? Yes NoIf no, please describe immigration status:IF THE AMOUNT IN THE MICRO-LOAN / MICRO-GRANT APPLICATION IS IN EXCESSOF 5,000.00, YOU MAY BE REQUIRED TO SECURE THIS PERSONAL GUARANTYWITH COLLATERAL.IF APPLICABLE, PLEASE PROVIDE THE FOLLOWINGINFORMATION:Type of collateral: Real Property Equipment Inventory Fixed AssetsIf collateral is real property, please provide the following information:StreetCityStateZipCurrent estimated fair market value:Property type: Residential Commercial Mixed UseIs the Property pledged the primary residence of the Individual responsible for thisSupplemental Application? Yes NoIs the Property pledged subject to an existing mortgage or loan? Yes NoIf yes, please provide the following information, as well as a copy of the tMaturityDateCurrentStatusSecuredLoan?If collateral is property other than real property, please describe with particularity thecollateral to be pledged, including the estimated fair market value of the property, thelocation of the property, and whether the property is pledged as collateral for some otherobligation or indebtedness:
BACKGROUND INFORMATION:Do you consent to a consumer report (background check), including but not limited tocriminal and credit history, being performed? Yes NoHave you ever been convicted of any criminal offense other than a motor vehicle violationor summary offense? Yes No If yes, please explain:Part V: Certification and AcknowledgmentThe undersigned hereby certifies that the statements in this application are true, correct, andcomplete. The undersigned further agrees that s/he will report any material changes to thecontents of this Application to the Mon Valley Alliance Foundation during the pendency andreview of the Application. The undersigned further acknowledges that s/he has read,reviewed, and understands the Program Policies and Procedures.The Mon Valley Alliance Foundation reserves the right to conduct and receive a consumerreport (background check) on the undersigned. Should such a consumer report be sought,appropriate notices and requests for permission to conduct a consumer report will beprovided to you.The Mon Valley Alliance Foundation further reserves the right to require co-signatories,guarantors, and/or endorsers for the approval of any loan application.SignatureFOR MVAF USE ONLY:Printed NameDATE RECEIVED:DateDATE REVIEWEDBY COMMITTEE:DATE REVIEWEDBY MVAF BoD:
please contact the Mon Valley Alliance Foundation at (724) 565-5636. No applicant or loan will be denied based upon race, religion, ethnicity, age, sex, sexual orientation, national origin, marital status, pregnancy, disability, an applicant's receipt of income from any public assistance agency, or any applicant's exercise of any and all rights
