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New Relationship_x____
BUSINESS INFORMATION
Business Name _________________________________
Address________________________________________
_________________________________________
Telephone ( ) _____________________ Tax I.D._________________
Individual Name(s)_______________________________________
Address____________________________________
_____________________________________
Telephone ( ) _____________ Social Security # ________________ Date of Birth: _______________
Proprietorship _______ Partnership _____ Sub-Chapter S _____ Corporation ______
Non-Profit _______ Individual ______ LLC ______
Ownership Distribution: (List stockholders, partners, owner names) Note: Attach separate sheet if additional space needed.
Name________________________ Title_______________ # of Years________ _____% SS#_______________
Name________________________ Title _______________ # of Years________ ______% SS#_______________
Name _______________________ Title_______________ # of Years________ ______% SS#_______________
Nature of Business _________________________________ Year Established______ Number of Employees_____
Years at Present Location __________ [ ] Own [ ] Lease
Accountant ______________________________ Telephone ( )_________________
Insurance Agent__________________________ Telephone ( )__________________
Attorney________________________________ Telephone ( )
FINANCIAL INFORMATION
Bank of Account ___________________________ Account Number __________________
Credit Relationships: Please provide details of your business credit relationships below:
Original Loan____________________ Amount $_____________ Maturity________
Name of Creditor_________________ Purpose of Loan______________ Amount________________
Presently Owing_______________ Repayment Terms_________ Date_________________
LOAN REQUEST
Amount of Loan Requested______________________ Type of loan___________________
[ ] Term Loan
[ ] Commercial Real Estate
Requested Term of Loan [ ] Business Home Equity
[ ] Other
Specific Loan Purpose (Check all that apply)
[ ] Finance Purchase of SCTS Franchise [ ] Other (State type of loan required and loan
Collateral Available* (Check all that apply)
[ ] All Assets (accounts receivable, inventory, machinery and equipment)
[ ] Specific Equipment (Please attach equipment list, including serial numbers or description of
equipment, and invoices for new equipment.)
[ ] Real Estate (Please attach property address, legal description and a copy of most recent tax bill.)
____________ Square Feet ___________Acres
[ ] Cash on Deposit at (name of bank)__________________________ Branch________________ Account #________________
[ ] Personal Assets (As described in Personal Financial Statement.)
* Collateral: Loans are secured by collateral, which is property in which a security interest is granted to secure repayment of the loan. The loan collateral
may include business assets, stocks, bonds, certificates of deposits, or personal assets. Consider (1) the value of the loan collateral must be equal to or
greater than the amount of the loan, (2) expected economic life of collateral will be considered by the Lender in evaluating the collateral offered for the loan, (3)
formal collateral appraisals may be required, and (4) a pledge of personal assets may be required as additional collateral for the business loan requested.
[ ] Guarantors** (Please list)
Name________________________________________ Social Security #________________________
Address_____________________________________________
______________________________________________
Name_________________________________________ Social Security #_________________________
Address________________________________________
________________________________________
Name_________________________________________ Social Security #__________________________
Address________________________________________
________________________________________
** Guarantors: For incorporated borrowers, guarantees of owner(s) are usually required, unless secured by Bank deposits or marketable collateral. If
personal assets are in joint names, a sole proprietorship, and/or partnership, the Lender may require all parties to pledge collateral.
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BUSINESS BACKGROUND INFORMATION
Please provide a brief history of your business, future plans and projections, and describe your products and/or services and competition.
(Attach statement, if necessary)
PERSONAL BUSINESS EXPERIENCE
If you have been in your present business for under five years, please describe your previous business experience. (Include business background,
management experience, and training, or include a resume.)
MISCELLANEOUS INFORMATION
Do you claim military status for discount? [ ] Yes [ ] No
If yes, What is your claim
[ ] Current Active Duty
[ ] Air Force [ ] Army [ ] Marines [ ] Navy
Give your rank (example: E-4 or O-4, not Sargent, Lt. Commander) ______ Date of Separation ___ / ___ / ______
Current Duty Station_________________________________________________________________
[ ] Dependent of Active Duty Military Stationed Overseas (Fill in information above for service member.)
Include copies of documentation (Military ID Card, Current Orders, or Letter from Commanding Officer)
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Are tax liabilities current? [ ] Yes [ ] No Settled through ________________________________
Is the business an endorser, guarantor, or co-maker for any obligation not listed in the financial statements? [ ] Yes [ ] No
If yes, what is the contingent liability?
Has the business or principal owner ever declared bankruptcy? [ ] Yes [ ] No
If yes, provide details on a separate sheet.
Is the business a defendant in any lawsuit? [ ] Yes [ ] No
If yes, provide details on a separate sheet.
Are any of the business assets encumbered by liens or attachments of any type? [ ] Yes [ ] No
What ________________________________ By whom ______________ Amount $________
What ________________________________ By whom ______________ Amount $________
Does the business have a pension fund? [ ] Yes [ ] No
profit-sharing plan? [ ] Yes [ ] No
If so, does the plan have any unfunded pension liabilities? [ ] Yes [ ] No Amount $_______________
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CERTIFICATION
The undersigned certifies that, to the best of his or her knowledge and belief, all information contained in this loan application and in the accompanying
statements and documents is true, complete, and correct. The undersigned agrees to notify the CCR immediately of any material changes in this information.
It is further agreed that, whether or not the loan herein applied for is approved, the undersigned will pay or reimburse the bank for the costs, if any, of surveys,
title or mortgage examinations, appraisals, etc., performed by non-CCR personnel with the consent of the applicant. The undersigned authorizes CCR to
contact any bank and trade creditors it deems necessary without further notice, including, but not limited to, Dunn & Bradstreet reports or information from TRW
Credit Data.
Business Name (print):______________________________________________________
Applicant Signature:_______________________________ Date: __________________
Applicant Title: ___________________________________
Guarantor(s) Signature: _____________________________ Date:___________________
Guarantor(s) Signature: _____________________________ Date:___________________
The undersigned certifies that, to the best of his or her knowledge and belief, all information contained in this loan application and in the accompanying
statements and documents is true, complete, and correct. The undersigned agrees to notify the Bank immediately of any material changes in this information.
It is further agreed that, whether or not the loan herein applied for is approved, the undersigned will pay or reimburse the bank for the costs, if any, of surveys,
title or mortgage examinations, appraisals, etc., performed by non-Bank personnel with the consent of the applicant. The undersigned authorizes the Bank to
contact any bank and trade creditors it deems necessary without further notice, including, but not limited to, Dunn & Bradstreet reports or information from TRW
Credit Data.
Business Name (print): _______________________________________________
Applicant Signature: __________________________________________________ Date:____________
Applicant Title:_____________________________
Guarantor(s) Signature: ______________________________________________ Date_____________
Guarantor(s) Signature: ______________________________________________ Date:____________
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