Submit the original
of the completed form in hard copy or facsimile to the appropriate USDA
servicing office.
Customers who have established electronic access
credentials with USDA may electronically transmit this form to the USDA
servicing office, provided that (1) the customer submitting the form is
the only person required to sign the transaction, or (2) the customer has an
approved Power of Attorney (Form FSA-211) on file with USDA to sign for other
customers for the program and type of transaction represented by this form.
Features for transmitting the form electronically
are available to those customers with access credentials only. If you would like to establish online access
credentials with USDA, follow the instructions provided at the USDA eForms web
site.
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Fld Name / |
Instruction |
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2A Name and Address of Loan Applicant |
Enter the name and complete address including ZIP code for the loan applicant who will be applying for the Facility Loan. |
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2B Tax Identification Number |
Enter the last 4 digits of the producer or loan applicant's tax identification number. If applying as an entity, use the entity’s ID number. |
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2C Telephone number |
Enter the telephone number including area code where FSA can contact you. |
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3A Requested Loan Amount |
Enter the requested loan dollar amount of the loan you are applying for. FSA is able to loan up to 85% of the cost of the proposed project, but not more than $500,000.00 per loan. Producers must show a need for the storage requested. Be sure to attach an itemized list showing the cost of the project. |
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3B Requested Loan Term |
Enter the requested loan term of the loan you are applying for. The loan term requested must be consistent with the eligible terms for the requested loan amount in Item 3A.
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4 Purpose of Loan |
Describe the proposed project and what the loan funds will be used for. Be sure to include the sizes of structures. For example ”I am applying for a loan to build a 20,000 bushel bin to be located next to my dryer bin.” |
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5A Farm Number |
Enter all FSA farm numbers where eligible facility commodities are produced and require storage at the proposed storage location. |
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5B Commodities |
Enter the facility loan commodity(s) that are produced on the farms that were entered in Item 5A. |
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5C Acres |
Enter your share of a three-year average acreage for the commodity entered in Item 5B. If a crop is being planted for the first time, enter a reasonable projected acreage. |
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5D Yield Per |
Enter a yield per acre for the crop indicated in Item 5B that could reasonably be produced each year. |
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5E Total Production for Each Commodity |
Enter the result of multiplying Item 5C (acres) times Item 5D (yield per acre). |
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5F Total Production |
Enter the results of adding all total production amounts in Item 5E. |
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5G Total Estimated Production Times Applicable Years |
For all eligible commodities except fruits and vegetables, multiply the estimated production total in Item 5F by 2. For cold storage facilities for fruits and vegetables, only 1 year storage capacity is eligible. Enter the total in Item 5F. |
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5H Existing Capacity |
Enter applicable suitable existing storage that is now used for the commodities listed in Item 5B. |
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5I Additional Capacity Needed |
Enter the result of Item 5G (Total Estimated Production Times 2) minus Item 5H (Existing Capacity) to determine the Additional Capacity Needed. |
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5J Capacity of Proposed Storage Structure |
Enter the capacity of the proposed structure described in Item 4. |
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5K Eligibility and Proration Indicator |
Enter the result of Item 5I (Additional capacity needed) minus Item 5J (Capacity of Proposed Storage Structure) to determine the Eligibility and Proration Indicator. |
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6 Date Facility Equipment Purchased… |
Enter the date the facility equipment was purchased or the tentative purchase date of when you propose to purchase the facility equipment. |
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7 Name of Company… |
Enter the name of the company or companies from which you plan to purchase the facility equipment. |
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8 Date Facility Equipment will be installed… |
Enter the date the facility equipment was erected, or installed, or the tentative date planned to erect or install the facility equipment. |
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9 Name of company … |
List the name or names of the company(ies) that erected or installed the facility equipment. |
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10 Date facility equipment was and or will… |
Enter the date the facility equipment was delivered or
will be delivered to the farm. Note:
Equipment can not be delivered to the farm until after the |
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11 Location of Real Estate… |
Enter the Real Estate Location on which Facility Equipment was erected or will be erected or installed. |
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12A Name of Owner… |
Enter the complete name or names of the owner of the real estate in Item 11, only if it is different than the producer or loan applicant who is applying for the loan. |
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12B Lien Information… |
List the names of all lien holders on the real estate where the storage will be located. |
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13 Certification of Delinquency |
Answer the question as to whether you or the co-applicant are delinquent on any federal debt. Enter a checkmark in the "YES" checkbox, if you or any co-applicant is delinquent on any federal non tax debt? If your answer is "YES", provide details in Item 18 "Remarks" on Page 2. Enter a checkmark in the "NO" checkbox, if you or any co-applicant is NOT delinquent on any federal non tax debt? |
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13A Signature |
The applicant shall sign. If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |
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13B Date |
Enter the date the application was signed by the applicant. |