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PARTICIPATION AGREEMENT SIGNATURE PAGE <br /> Member <br /> Name of Member <br /> (Please Print) <br /> Signature of Authorized Officer <br /> Name of Authorized Officer <br /> (Please Print or Type) <br /> Title of Authorized Officer <br /> Address of Member <br /> (Business Address <br /> (City, State,Zip) <br /> (Facsimile Number) <br /> (E-mail address) <br /> Authorized Representative • <br /> Address of Authorized Representative <br /> (Business Address) <br /> (City,state,zip) <br /> (Facsimile Number) <br /> (E-mail address) <br /> Federal Tax Identification No. <br /> State Tax Identification No. <br /> Amount of Member Funds to be Deposited <br /> in Loan Fund <br /> Dated: , 200_ <br /> Minnesota Community Capital Fund <br /> By <br /> Its <br /> Dated: , 200_ <br /> i <br /> 4 <br />