Reinvestment Fund - Initial Financing Request Form for an Energy Efficiency LoanPage 1

Initial Financing Request Form

for an

Energy Efficiency Loan

1. Contact Information for Person Completing this Application
Name: / Title:
Telephone: -- x / Cell Phone: -- / Email:
2. Information about the Applicant
Legal Name of Business/Organization: / Year Established:
Address: Street: / City: / State: / Zip:-
Purpose, Work or Services of Business/Organization:
Legal Structure (check one): Non-Profit Corp. For Profit Corp. Limited Partnership General Partnership
Limited Liability Company Sole Proprietorship Other:
3. Information about the Proposed Energy Project to Achieve Energy Savings
Project Name:
Project Address: Street: / City: / State: / Zip:-
Year Building Built: / Building Gross Sq Ft: / Number of Floors:
Number of Liens on Property: / Total Outstanding Value of Debt being Secured by Liens on Property: $
Project Type(s): (check all that apply)
Limited Energy Retrofit or Equipment Replacement in Existing Building Gut Rehab of Existing Building
Extensive Building Energy Retrofit in Existing Building New Construction
Brief Project Description:
Project Dates: Estimated Project Start Date: / Estimated Project Completion Date:
At what stage are the architectural/engineering plans for this project?
For Retrofits of Existing Buildings: Has an energy audit or other analysis been performed to quantify the project’s energy savings? / Yes No In process N.A.
For Gut Rehab or New Construction: Has a building energy simulation model been completed to predict the building’s energy consumption? / Yes No In process N.A.
4. Project Budget
Cost Category / Budget / Degree of Certainty about Cost
Real Property Acquisition / $
Project Soft Costs / Pre-development Costs / $
Project Hard Costs – Energy Measures / $
Project Hard Costs – Non-energy Measures / $
Other: / $
Total: / $
Important Comments about the Project Budget:
5. Energy Loan Request and Other Project Financing
Reinvestment Fund Energy Loan Request: / $
Other Potential Project Financing:
Amount: / Source / Status
Other Loan / $
Other Loan / $
Public Grants / $
Utility rebates / $
Other: / $
Applicant Equity / $
Project Total (including thisloan request) / $
Important Comments about the Project Financing:

11/23/15

Reinvestment Fund - Initial Financing Request Form for an Energy Efficiency LoanPage 1

About the Initial Financing Request Form for an Energy Efficiency Project

This form is for a project that is primarily an energy conservation/efficiency project for a building. There is a different Initial Financing Request Form for clean energy production projects involving renewable energy generation or other clean energy technologies. To obtain a copy of that form, please visit the Reinvestment Fund Energy webpage at

This form is not the full loan application form, but rather an abbreviated form to begin the discussion about yourclean energy project and possible financing by Reinvestment Fund. When this form has been completed and submitted, it will be reviewed by Reinvestment Fund staff, who will discuss your project with you and then decide if it appropriate to go to the next step of completing a full loan application package for your project.

Reinvestment Fundmanages many different funds that support energy projects and this form will suffice for all of them. You do not need to decide which of Reinvestment Fund’s different energy loan programs is right for your project.

Directions for Completing and Submitting the Initial Financing Request Form

The Initial Financing Request Form for an Energy Efficiency Project is a Microsoft Word document. Simply type the requested information in the highlighted fields, check the appropriate boxes and save the document with a unique file name. The text fields will expand as you type, so do not feel that your answer is limited by the size of the text box. It is important that your answers provide all of the important details. Do not worry if the page breaks of the completed form do not match those of the blank form.

You may not know all of the information being requestedon the Initial Financing Request Form. That is usually the case and should not prevent you from submitting the form. Reinvestment Fund prefers to learn about your project early rather than at the end of the predevelopment phase.

Please submit your completed Initial Financing Request Formby email .

Or you may mail it to:Roger E. Clark

Reinvestment Fund

1700 Market Street - 19th Floor

Philadelphia, PA 19103

Questions

Questions about Reinvestment Fund’s financing for energy projects should be directed to Roger Clark at or 215.574.5814.

11/23/15