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Business Loan Application
Applicant Contact
Important: Enter a valid e-mail address. Correspondance will be sent to this address.
Name*

Phone*

E-Mail:*

Company Information
Business Name*

Address Line 1:

Address Line 2:

City:*

State:*

Zip Code:*

Business Phone:*

Fax Number:*

Cell Phone:

Type of Business:*

Established Date*

Type of Ownership*
Corporation
LLC
Partnership
Sole proprietor
Government
Non-Profit

Years established*

Years at present Location*

Employer Identification Number(EIN)*

Parent Company Name, Address & Phone

Number of Employees*

Tax Exempt*
Yes No 

Officers
For Sole Proprietor or Partnership: List all Owners and/or Partners.
For Corporation or Limited Liability: List all Officers, Directors, Members and Majority Stockholders.
Name*

Title*

Home Address*

Phone*

Soc Sec #*

Ownership %*



















Amount and Type of Credit Request
Credit Amount Requested:*

Desired Payment:*

Purpose of Credit*
Financial Purchase of Inventory
Finance Purchase of Equipment
Finance Purchase of Real Estate
Finance Purchase of Business
Refinance Existing Loan Debts
Other Purpose

Other Purpose*

Bank Reference
Bank Name:*

Account Number:*

Balance:*

Bank Name:

Account Number:

Balance:

Credit Reference
Credit Reference:*

Account Number:*

Balance:*

Credit Reference:

Account Number:

Balance:

Miscellaneous Information
Are tax liabilities current?*
Yes No 

Has the business or principal owner ever declared bankruptcy?*
Yes No 

Is the business a defendant in any lawsuit?*
Yes No 

Are any of the business assets encumbered by liens or attachments?*
Yes No 

Acceptance
I agree to furnish current financial statements?*
Yes No 

I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AUTHORIZE IT`S VERIFICATION
AND THE OBTAINING OF A CREDIT REPORT.
 
I understand any false or misleading statements in my application may cause any loan to be in default. I agree
that this application shall be this Institutions`s property whether or not this credit application is approved.
 
By entering my first & last below, I stipulate that I agree to all of the terms and conditions stipulated on this application.
Signature:*

Title*

Dated:*

Enter your first and last name in the signature space above.
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