Infrastructure Loan Application

STEPHEN P. DEPALMA INFRASTRUCTURE LOAN FUND

LOAN APPLICATION FORM

Please provide the following information:

Individual Submitting Application *

Email Address *

Phone *

Chapter *

Date *

Requested Loan Amount *

Intended Use of Funds *

Chapter House

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Ownership Information *

Chapter Information

In House Dues *

Out of House Dues *

Rent (please note total monthly or annual) *

House Capacity *

# Living In this Year

Accounts Receivable End of Last Month *

Accounts Payable End of Last Month *

Mortgages (if applicable)

1. $ *

Balance Holder *

2. $

Balance Holder

3. $

Balance Holder

Amount in Current Checking or Savings Accounts *

The Housing Corporation (or chapter) must be able to provide Pi Kappa Phi Properties, Inc. the past three years financial information stated below: Tax returns for past three years (IRS form 990’s) Current Housing Corporation (or chapter) budget. Bank statements for checking and savings accounts in Housing Corporation’s (or chapter's) name. Current long-term savings plan for the chapter house. Provide a written summary of past fund-raising efforts and successes in regard to housing monies over the past three year period.

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Please submit a picture of the chapter house or lodge and an additional picture that shows the area of the house that is to be worked on. (if applicable)

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Use of Funds

Explain in detail so persons removed from your situation will understand what you intend to do with the money. If repair work is involved, include full details and contractor’s estimate. This is important as distribution of funds requires that the project be fully detailed. *

STEPHEN P. DEPALMA INFRASTRUCTURE LOAN FUND

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