Business Name:
	Telephone:
	Fax:
	Email:

SOURCES	AMOUNT	USES	AMOUNT
1. State Loans:		1. Start-up Costs:
a.		a. R&D
b.		b. Working Capital
c.		c. Personnel
2. Federal Loans:		d. Other:
a.		2. Icubator Fees:
b.		3. Machinery and     Equipment:
c.		4. Working Capital:
3. Subordinated Debt:		5. Revolving Lines of     Credit:
a.		6. Contracts:
b.		7. Leasehold     Improvements:
c.		8. Furniture & Fixtures:
4. Equity Investments:		9. Inventory:
5. Bank Loans*:		10. Soft Costs (Studies,      etc.):
a.		11. Standby Letter of      Credit:
b.		12. Trade Credit Lines:
c.		13. Franchise Fees:
6. Other Sources:		14. Stock Purchase:
a. Government         Grants		15. Refinancing:
b. Other Incentives		16. Relocation/Moving:
7. Cash from Operations:		17. Employee/      Recruitment Training:
8. Others:		a. New
a.		b. Existing
b.		18. Other Uses:
c.		a.
		b.
TOTAL SOURCES:		TOTAL USES:
NET:

* Attach Commitment Letters