Referral Form

    SOUTH CAROLINA COMMUNITY CAPITAL ALLIANCE

    LOAN REFERRAL FORM

    All information provided herein is deemed confidential and will not be shared

    1. REFERRING ORGANIZATION

    Organization Name: (if applicable)

    Contact Name and Title:

    Street Address:

    City:

    State:

    Zip Code:

    County:

    Telephone Number:

    Fax Number:

    Email Address:

    2. BORROWER INFORMATION

    Organization Name: (if applicable)

    Contact Name and Title:

    Street Address:

    City:

    State:

    Zip Code:

    County:

    Telephone Number:

    Fax Number:

    Email Address:

    3. BORROWER TYPE


    Other:

    4. BUSINESS OR PROJECT INFORMATION

    (Please include address where your business or project is or will be located, if applicable)

    Name: (if applicable)

    Street Address:

    City:

    State:

    Zip Code:

    County:

    Description:

    5. LOAN INFORMATION

    Loan Amount Needed:

    Description of Use of Proceeds:

    Description of Collateral: (if applicable)

    6. LOAN TYPE

    7. LOAN PURPOSE (Select All That Apply)


    Other:

    8. LOAN TERM NEEDED

    9. LOAN IMPACTS

    Located in Low to Moderate Income Census Tract?

    Located in USDA Designated Food Desert?

    Located in USDA Designated Rural Community?

    Will Employ Low to Moderate Income Individuals?

    Will SERVE or HOUSE Low to Moderate Income Individuals?

    Estimated Number of JOBS to be Created/Retained:

    Estimated Number of UNITS to be Created/Rehabilitated:
     30% AMI
     50% AMI
     80% AMI
     120% AMI

    10. ADDITIONAL INFORMATION

    Description: