Loan Application

(failure to provide all required information could result in delay of approval)

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Company Information
Company Name
Address City State Zip
Princial in Charge Wk Phone ( ) Wk Fax ( )
Email
Secondary Contact Wk Phone ( ) Wk Fax ( )
Email
Type of Business Date Established / /
Type of Entity (Check One) Proprietorship Partnership LLC Corporation - Yrs Business Incorporated
Number of Current Employees Estimated Number of New Employees Within the Next Two Years Due to Loan

New Project Information
Street Address of Project
City County State Zip
What is the square footage of the new building? What is the square footage that the business will occupy?
* SBA requires that a business occupy at least 51% of an existing building or 60% of a new building
Closing Date / / Realtor's Name Phone ( )
How will the property be vested (i.e. individually, partnership, LLC, ...)?
If there are any tenants that will remain in the building, please provide the following information: (please provide copies of existing leases)
Tenant Name Square Footage Lease Expiration Rent Amount  
/ / $ remove
Add Entry

Reference
Bank Name Account Officer Ph. ( )
Firm Name Accountant Ph. ( )
Firm Name Attorney Ph. ( )

Company Ownership
Name Title % Ownership remove
Add Entry

Affiliate Businesses
Business Name Owner % Ownership remove
Add Entry

Existing Business Locations
Business Address Own Lease Replaced by new facility? Yes No
Sq Ft. Mortgage/Lease Payment $ Lease Exp. / / remove
Add Entry

Personal Resume Form
Name Gender Male Female
  first middle last (optional)    
Former Name When Used:
  first middle last  
Date of Birth / / Place of Birth
Home Phone ( ) Business Phone ( )
Home Address
  street city state zip from to
Previous Address
  street city state zip from to
Are you employed by the U.S. Government? Yes No        Agency/Position
U.S. Citizen? Yes No        If no, give alien registration number
Spouse Name SSN# Date of Birth / / Place of Birth

With which race do you more closely identify? Choose only one (optional)

African American Native American Eskimo or Aleut
Asian or Pacific Islander White Hispanic
Other
remove
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Total Project Costs
  Enter Dollar Amounts
Real Estate (Land and Building) $
New construction / Expansion / Repair $
Improvements to Leased Property $
Construction contingency $
Acquisition and/or repair of machinery and equip $
Acquisition and/or repair of fixtures $
Inventory Purchase $
Working Capital (including loan fees) $
Acquisition of existing business $
Total Business Costs $
  Enter Dollar Amounts
Professional Fees  
Architect Fees $
Engineering Costs $
Appraisal Fees $
Environmental Fees $
   
Other Costs  
Interim Interest $
$
   
Total Soft Costs $
Total Project Costs $

Personal Financial Statement
ASSETS
  (omit cents)
Cash on hand & in Banks $
Savings Accounts $
IRA or Other Retirement Account $
Accounts & Notes Receivable $
Life Insurance - Cash Surrender Value Only
(describe below) 		$
Stocks & Bonds (describe below) $
Real Estate (describe below) $
Automobile - Present Value $
Other Personal Property (describe below) $
Other Assets (describe below) $
Total Assets $
LIABILITIES
  (omit cents)
Accounts Payable $
Notes Payable to Banks and Others (describe below) $
Installment Account (Auto)
Mo. Payment $ 		$
Installment Account (Other)
Mo. Payment $ 		$
Loan or Life Insurance $
Mortgages on Real Estate (describe below) $
Unpaid Taxes (describe below) $
Other Liabilities (describe below) $
Total Liabilities $
Net Worth $
Section 1
Source of Income
  (omit cents)
Salary $
Net Investment Income $
Real Estate Income $
Other Income (describe below)* $
Contingent Liabilities
  (omit cents)
As Endorser or Co-Maker $
Legal Claims & Judgments $
Provision for Federal Income Tax $
Other Special Debt $
* Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted towards total income.
Description of "Other Income" in Section 1
Section 2 - Notes Payable to Banks and Others
Name and Address of Noteholder(s) Original
Balance 		Current
Balance		 Payment
Amount		 Frequency
(monthly, etc.)		 How Secured or Endorsed Type of Collateral  
$ $ $ remove
Add Entry
Section 3 - Stocks and Bonds
Number of Shares Name of Securities Cost Market Value
Quotation/Exchange		 Date of Quotation/Exchange Total Value  
$ $ / / $ remove
Add Entry
Section 4 - Real Estate Owned
Type of Property Address Date Purchased / /
Original Cost $ Present Market Value $
Name and Address of Mortgage Holder
Mortgage Account Number Mortgage Account Balance $ Amount of Payment per Month/Year $ Status of Mortgage
remove
Add Entry
Section 5 - Other Personal Property and Assets (Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and if delinquent, describe deliquency)
Section 6 - Unpaid Taxes (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches)
Section 7 - Other Liabilities (Describe in detail)
Section 8 -Life Insruance Held (Give face amount and cash surrender value of policies - name and insurance company and beneficiaries)

Operating Company Profile
Company Name
Describe the type of business you are in and how/why you became involved.
Type of products or services offered (including and catalogues or brochures)
Geographic market area served
What is your outlook concerning the business activity in which you are engaged?
How will this loan benefit your company?
Will this loan create new employment opportunites Yes No If yes, how?

Customer Profile
What primary markets use your products?
List key customers
List major competitors
Major suppliers
Future plans (what is your growth strategy? Rapid growth, moderate, or maintain market position? What may impact your success?)
Major past accomplishments, how your business differs from the competition, and your competitive advantages:
Marketing analysis and strategy (Explain your promotional, pricing, and distribution strategies.)

Previous SBA or Other Federal Government Debt
Name of Agency Original Amount of Loan remove
Date of Request /