| Please choose types of loan you are applying
for (check as many as apply)
1. General Information
Please fill out the following:
2. Ownership/Management Structure
Please choose
one form of Mangagement Structure
Please declare percentages, names of companies owned and
by whom:
Please list Key Management
Please list Subsidiaries or Affiliates (Owned
by applicant or by management or owners of applicant)
3. Company History/Profile
Please
enter information on your 4 largest Customers
Please enter information on your 4 largest suppliers
4. Description of Proposed Financing
5. Support Information
The Following Information
may also be Required:
- 2-3 Years of Financial Statements and Tax Returns
for borrower(s)
- Current Personal Financial Statements and 2 years
of tax returns for all principals or guarantors.
- Receivables Aging, Backlog, Contract Progress
Reports (if applicable)
- A list of subject inventory, and/or subject equipment
with serial numbers (ifapplicable)
- A list describing Marketable Securites and number
of shares. (if applicable)
- Sales Contract and/or Purchase Agreement (if applicable)
- Financial projections and Business Plan (if applicable)
Name and Address of Landlord
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By signing or submitting this application the applicant(s)
specifically acknowledge and agree that: (1) All statements
made in this application are made for the purpose of obtaining
the loan indicated herein; (2)Verification or reverification
of any information contained in the application may be made
at any time by the lender, its agents, successors, and assignees,
either directly or through a credit reporting agency, from
any source named in this application; (3)The original copy
of this application will be retained by the lender, even
if the loan is not approved;(4)The Lender, its agents, successors
and assignees will rely on the information contained in
the application and I/we have a continuing obligation to
amend and/or supplement the information provided in this
application if any of the material facts which I/we have
represented herein should change prior to closing; (5) In
the event my/our payments on the loan indicated in this
application become delinquent, the lender, it's agents,
successors and assignees, may, in addition to all other
rights and remedies, report my/our name(s) and account information
to a credit reporting agency; (6) ownership of the loan
may be transferred to a successor or assign of the Lender
without notice to me and/or the administration of the loan
account may be transferred to an agent, successor or assignee
of the Lender with prior notice to me; and (7) that all
expenses for legal fees, title examination, appraisal, and
settlement or other charges of the loan are to be paid by
the borrower.
Certification: I/We certify that the information provided
in this application is true and correct as of the date of
submission on this application and acknowledge my/our understanding
that any intentional or negligent misrepresentation(s) of
the information contained in this application may result
in civil liability and/or criminal penalties including,
but not limited to, fine or imprisonment or both under the
provisions of Title 18, United States Code, Section 1001,
et seq. and liability for monetary damages to the Lender,
its agents, successors and assigns, insurers and any other
person who may suffer any loss due to reliance upon any
misrepresentation which I/we have made on this application.
Please bring this loan application to the location which is most convenient to you.
We will need your signature and identification to be provided
at any one of our locations for the new loan documents.
(It can be provided at any one of our convenient locations).
Upon receiving your application, we will attempt to contact
you within 24 hours and notify of any additional information
needed for this loan. If you should not hear from us, please
contact us at 940-686-7000. |
