Business Loan Application

Amount Requested $
Minimum Amount Needed $
Describe the Type of Loan, Reason for your Loan and Use of Funds Requested - (Be specific)

GENERAL BUSINESS INFORMATION

Legal Business Name
DBA
State Tax ID Number
Federal Tax ID Number
Contact No.
Street
City
State
Zip
Any Open or Old Tax Lien(s) $
Total Assets $
Total Liabilities $
Net Worth $
Nature of Business / Company Type
Website
Business Inception Date
No. of Employees
Dunn & Bradstreet #
Revenues Gross: 2016 $
Revenues Gross: 2017 $
Revenues Gross: 2018 $
Thru Month
Net: 2016 $
Net: 2017 $
YTD: 2018 $
Thru Month

APPLICANT INFORMATION

First Name
Last Name
Compny Title
Home Phone
Cell Phone
Email Address
Home Address
City
State
Zip
Social Security Number
Date of Birth
% Ownership
Total Household Income (yearly) $
Total Assets $
Total Liabilities $
Marital StatusMarriedSingleSeparatedDivorced

CO-APPLICANT INFORMATION

First Name
Last Name
Compny Title
Home Phone
Cell Phone
Email Address
Home Address
City
State
Zip
Social Security Number
Date of Birth
% Ownership
Total Household Income (yearly) $
Total Assets $
Total Liabilities $
Marital StatusMarriedSingleSeparatedDivorced

BANKING AND ACCOUNT INFORMATION

01

Bank/Institution
Account #
Type of Account:
Average Monthly Deposits $
Contact Name
Phone
Date Opened:
Current Balance

02

Bank/Institution
Account #
Type of Account:
Average Monthly Deposits $
Contact Name
Phone
Date Opened:
Current Balance

Real Estate Owned

Value of Residential Real Estate Owned (total of all combined if more than one) $
Mortgage Balance(s) $
Value of Residential Real Estate Owned (total of all combined if more than one) $
Mortgage Balance(s) $
Land Lord Information (If you don't own your commercial property/business location please fill out Landlord info).
Landlord Holder Name
Phone
How many years remain on Lease

Business Equipment Owned (Free and Clear)

Office Equipment & Furnishings $
Equipments
Industrial and Manufacturing Equipment $
Construction and Farm Equipment $
Equipments
Medical and Dental Equipment $
Other $
Do you plan to purchase equipment? Yes or No If yes, type:
Vendor Name:
Vendor Phone:
Contact Person:

Receivables & Purchase Orders

Total receivables $
Purchase Orders $
Have you received PO financing previously?
If yes, who was the lender?:

Merchant Account

Average Monthly Credit Card Volume (Visa/MasterCard): $
How Many Merchant/Credit Card Accounts?
Merchant/Credit Card Processing Info: Processor:
Contact No.
Terminal Type:
How Processed: % Card Swiped:
% Manually Keyed:
% Phone/Mail Order:
% Internet:
Do you have any existing 'cash advances' and/or 'bank statement loans?
Balance(s) & with whom:

TRADE REFERENCE(S) (The longer the trade reference has been open the better and will be verified).

Company Name
Account No
Phone Number
Open Date
High Credit
Current Balance
Contact Name
Company Name
Account No
Phone Number
Open Date
High Credit
Current Balance
Contact Name
Company Name
Account No
Phone Number
Open Date
High Credit
Current Balance
Contact Name

CREDIT EVALUATION

Do you know your personal credit score? Yes or No If so, what are Score(s)?
Do you know if you have a D & B Business Credit File?
Do you know your D & B Paydex Score?
Do you have any UCC Lien Filings? Yes or No Amount(s)?
What is the UCC Filing on?
Do you have any existing Credit Lines? Yes or No Balance(s)?
With Who?

MISCELLANEOUS INFORMATION

Do you have any federal & state taxes past due? Yes or No If yes, how much: Federal $
State $
Are you currently under the protection of the United States Bankruptcy Laws?
Have you been turned down previously:(This information is critical in determining what issues that need to be overcome).
By whom and Reason(s):
Are you currently working with any lender, consultant or broker on this transaction? Yes or No
If yes, who:
If Yes, Who:

AGREEMENT

I/We completed an application containing various information and certify that all of the information is true and complete. I authorize the lender to investigate my creditworthiness and verify any information provided on my/our application and other related documents.

Business Name
Printed Name
Title
Date
Signature

AUTHORIZATION TO OBTAIN CREDIT INFORMATION

I / We represent and warrant that the information provided in this credit application is complete, accurate and true. Each individual signing below also requests and authorizes any lenders or funding source which may be utilized (collectively referred to as “Lenders”) to obtain information from the references listed above and obtain commercial and/or consumer credit histories that will be ongoing and relate not only to the evaluation of the business credit requested, but also for purposes of reviewing the account, increasing the credit line on the account (if applicable), taking collection action on the account, and for any other legitimate purpose associated with the account as may be needed.

A facsimile, electronic or other copy of this signed authorization shall be as valid as the original.

Applicant’s Printed Name
Date
Applicant’s Signature
Applicant’s Printed Name
Date
Applicant’s Signature
Applicant’s Printed Name
Date
Applicant’s Signature