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REPRESENTATIVE
Who has been assisting you?
BROKER
Company Name
Application Submitted By
Phone
Loan Amount
Purpose of the loan?
BUSINESS INFORMATION
Business Name
Doing Business As
Address
Phone
City
State
Zip Code
Country
Tax ID/SSN
No. of Employees
Nature of Business or SIC
Year Established
State of Org.
Annual Sales Revenue
Annual Net Profit
Type of Organization
C-Corp   S.Corp   Sole Prop.   LLC   Limited Part.   General Part.   LLP   Other
OTHER INFORMATION
Are you a U.S. citizen?
Yes   No 		Length of time you have owned the business
Date business was started
Is your place of business leased or owned
Owned   Leased
Monthly Payment
Value
Date of Incorporation
Who do you do your business banking with
12 Month Avg Balance
Current A/C Balance
Who do you do your personal banking with
12 Month Avg Balance
Current A/C Balance
Depreciation expense
Interest expense
Additional household income
Have you applied for credit in last 60 days
Yes   No
Do not apply for credit elsewhere as it may result in your application(s) being denied.
MANAGEMENT INFORMATION (The personal guaranty of the owner(s) is required. Use additional applications if necessary)
OWNER 1
Name
Date of Birth
Title
% Owner
# Years Owned
Home Address
Years at Address
City
State
Zip Code
Home Phone
Drivers License Number
State
Issue Date
Expiration Date
Social Security No
Monthly Mortgage & Taxes/Rents
Credit Score
 
Note: Attorney , child support or separate maintenance income need not be disclosed if you do not choose to have it considered as a basis for repaying this loan.
Adjusted gross income as reported on Federal Tax Returns.
 
$ Year
Asset Ownership : J/A= Joint Asset                     (Please provide name below if jointly owned)
Personal Assets J/A Personal Liabilities J/A
Liquid Assets Personal Mortgage Bal.
Retirement Assets Home Equity Bal.
Personal Residence Installment Bal.
Investment Real Estate Credit Card Bal.
Networth of Business Owned Contingent Liabilities
Other Assets Other Debts
Total Assets Total Liabilities
Net Worth (Total Assets - Total Liabilities):
Please answer the following: Yes   No
Have you ever declared bankruptcy?
Do you have any law suits pending against you?
Do you have any taxes that are past due?
Have you ever defaulted a loan?
Do you have any other credit application pending?
Does your business have unsecured credit at other institutions?
Dollar amount of line/loan
Name of institution
If you answered yes to any of the above questions or have checked jointly owned, please describe.
OWNER 2
Name
Date of Birth
Title
% Owner
# Years Owned
Home Address
Years at Address
City
State
Zip Code
Home Phone
Drivers License Number
State
Issue Date
Expiration Date
Social Security No
Monthly Mortgage & Taxes/Rents
Credit Score
 
Note: Attorney , child support or separate maintenance income need not be disclosed if you do not choose to have it considered as a basis for repaying this loan.
Adjusted gross income as reported on Federal Tax Returns.
 
$ Year
Asset Ownership : J/A = Joint Asset                     (Please provide name below if jointly owned)
Personal Assets J/A Personal Liabilities J/A
Liquid Assets Personal Mortgage Bal.
Retirement Assets Home Equity Bal.
Personal Residence Installment Bal.
Investment Real Estate Credit Card Bal.
Networth of Business Owned Contingent Liabilities
Other Assets Other Debts
Total Assets Total Liabilities
Net Worth (Total Assets - Total Liabilities):
Please answer the following: Yes   No
Have you ever declared bankruptcy?
Do you have any law suits pending against you?
Do you have any taxes that are past due?
Have you ever defaulted a loan?
Do you have any other credit application pending?
Does your business have unsecured credit at other institutions?
Dollar amount of line/loan
Name of institution
If you answered yes to any of the above questions or have checked jointly owned, please describe.

 

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