Section 1 of 1 in this document

NYSERDA New York Loan Loss Reserve Program

Thank you for your interest in participating in the NYSERDA New York Loan Loss Reserve Program.

Please note: Partially completed information cannot be saved, be sure to have all details with you before beginning the form. For the best form completion experience, use the Google Chrome browser. Upon submission, you will receive a confirmation and a Tracking ID number on your screen. You should print or save this tracking number and refer to it when checking on the status of your application.

If you have any questions, feel free to contact NYSLLR@nyserda.ny.gov.

* Required field

Applicant Information

Legal Business Name

Business Website

Title

Phone

Extension

Is the contact person’s address the same as the business address listed above?

Yes

Applicant Organizational Information

Institution Type

Insured Bank or Credit Union

Community Development Financial Institution (CDFI)

Financial Development Corporation (FDC)

Other Finance Lender

Other Lender - Please Specify

Provide the name of the Regulatory and Insuring Agencies overseeing your institution and any license numbers, if applicable.

Regulatory Agency Name(s)

N/A

License Number(s)

N/A

Insuring Agency Name(s)

N/A

Do you have a NY Finance Lenders License?

Yes

Required Upload(s)

Products Offered Details

Geographic Area(s) in New York Where the Financing Program(s) Will be Available

Loan Loss Reserve/Credit Enhancement

Insurance Certificate(s)

Required Upload(s) for Non-Regulated Institutions

Non-Profits can provide this documentation if they have capability.

NYS Department of State Certificate

Last Three Years of Income Statements and Estimated Balance Sheets

Finance Provider Applicant’s Quality Control and Management Systems

Proof of at least $1 million in net worth and assets

Underwriting Qualifications

Origination Qualifications

Servicing Qualifications

Certification

By electronically submitting this application, I attest that I have read, understand, and agree to comply with the acknowledgments, certifications, representations, and warranties listed in the PON, including Attachment B Loan Loss Reserve Program Terms and Conditions. Additionally, I authorize NYSERDA and entities doing business on NYSERDA’s behalf to add me to the mailing lists and to share my information with other New York State government entities. My information will not be shared outside of New York State government, and I reserve the right to unsubscribe at any time.

Applicant Signature

First Name

Last Name

Choose how to sign

Draw Type

I, the undersigned, hereby certify that all of the information provided in this application is true and accurate to the best of my knowledge and I am authorized to legally bind the applicant.

Tracking Number

You will be provided with a Tracking Number upon submission.