COHFA Application

Application for Financing

This form can be filled out online. After entering all applicable information, press the “Submit Form” button at the bottom of the page to send your application to our office. If you would prefer to print your application and send it via mail, use the print function in your browser and send it to the mailing address above. If you choose to send your application via mail, please include two copies of audited financial statements for the last three years and two copies of your interim unaudited financial statement for the current period.

Facility

Facility name

Street address

City

State

Zip code

Website URL

Phone

Fax

Applicant’s Representative

Representative’s name

Street address

City

State

Zip code

Phone

Fax

Legal Counsel

Counsel’s name

Street address

City

State

Zip code

Phone

Fax

Financial Advisor (if any)

Financial Advisor’s name

Street address

City

State

Zip code

Phone

Fax

Investment Banker/Agent (if selected)

Investment Banker/Agent’s name

Street address

City

State

Zip code

Phone

Fax

Financial Feasibility Consultant (if any)

Consultant’s name

Street address

City

State

Zip code

Phone

Fax

Purpose of Proposed Financing

Please write a brief description of the purpose of the proposed financing, including location(s) where bond/note proceeds will be used. For start-up facilities, please attach copies of any projections or studies regarding occupancy, revenues and expenses.

Purpose

Total Amount of Requested Funds

Please enter the total amount of requested funds known at the time of this application.

Total in $

Estimated Sources and Uses

Please enter estimated sources and uses for the project(s) to be financed with bond/note proceeds.

Sources

Current Status

For debt refinancing or equipment financing, please enter a brief description of current status and time table for required actions.

Current status

For new construction, or renovation/remodeling:

Date work began or will begin

Date of completion/occupancy

Existing Facilities and Programs

Please write a brief description of the Applicant's existing facilities and programs.

Existing programs

Additional Documents

After reviewing your application, COHFA will contact the Applicant’s representative via email for the following documents:

• Audited financial statements for the (3) most recent years
• Interim unaudited financial statement for the current period

The Authority and its consultants or advisors may request additional information. Such requests will be pertinent to the particular Applicant or proposed financing, and will be kept to a minimum.

The Authority is willing to consult with applicants considering a financing.