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PARTICI~PATION AGREEMENT SIGNATI~E PAGE <br /> <br />Member <br /> <br />Name of Member <br /> <br />Signature of Authorized Officer <br />Name of Authorized Officer <br /> <br />Title of Authorized Officer <br />Address of Member <br /> <br />(Please Print) <br /> <br />(Please Print or Type) <br /> <br />(Business Address <br /> <br />(City, State, Zip) <br /> <br />(Facsimile Number) <br /> <br />(E-mail address) <br /> <br />(Business Address) <br /> <br />(City, state, zip) <br /> <br />(Facsimile Number) <br /> <br />(E-mail address) ' <br /> <br /> · 200 <br /> <br />Authorized Representative <br /> <br />Address of Authorized Representative <br /> <br />Federal Tax Identification No. <br /> State Tax Identification No. <br /> <br />Amount of Member Funds to be Deposited <br />in Loan Fund <br /> <br />Dated: <br /> <br />Minnesota Community Capital Fund <br /> <br />By <br /> <br />Its <br /> <br />Dated: <br /> <br />· 200 <br /> <br /> <br />