LOAN APPLICATION Rev. 11/08 Applicant’s name(s)__________________________________________ Total loan amount requested___________________ Date_____________________ Purpose of loan_________________________________________________________________________________________________________________________________________________ List types and fair market value of the collateral for this loan__________________________________________________________________________________________________________________________________________________________________________________ Have you been denied by any other lending institutions for this project? (Please check one) ___Yes ___No Have you ever be turned down for a business loan?__________________________ If yes, institution’s name_____________________________________________ Date of denial___________________ Amount requested___________________ Reason stated for denial_____________________________________________ _________________________________________________________________ Have you ever been an owner of another business in the past? (Please check one) ___Yes ___No If yes, please provide details__________________________________________ _________________________________________________________________ Do you have plans over the next 6 months to apply for any funding from other financial institutions? (Please check one) ___Yes ___No If yes, please explain________________________________________________ Name of Financial Institution__________________________________________ Projected application date__________________ Amount___________________ Reason___________________________________________________________ BUSINESS INFORMATION (If applicable) Business name_________________________________ Phone__________________________ Business address________________________________________________________________ Type of business (please check one) ___Retail ___Service ___Manufacturing ___Wholesale Business start-up date_________________ Federal tax ID number____________________ Business legal structure (Please check one) ___Sole Proprietorship ___General Partnership ___ LLC ___C Corp. ___S Corp. Date of incorporation_____________ State_______ NAICS code___________ List Company Officers and Directors Name Position in business % Ownership 1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ 4. _______________________________________________________________ 5. _______________________________________________________________ How many days a week will the business be open? ______________________________ Number of hours worked per week by owner_____________________________________ Current Number of Employees Part-time___ @ Hourly rate range $_______ Hours worked per week_______ Full-time___ @ Hourly rate range $_______ Hours worked per week______ Family___ @ Hourly rate range $_______ Hours worked per week______ Self___ @ Hourly rate range $_______ Hours worked per week______ Do you plan on providing health/retirement benefits to your employees? ___Yes ___No If yes, what plans have you looked into and what cost will be involved? _________________________________________________________________ List approximate number of projected positions that will be available once you receive the loan. ___Part-time ___ Full-time Business Credit References (please use additional sheets of paper if necessary) 1. Name____________________________________________________________ Address__________________________________________________________ Phone______________________ Account #_____________________________ Credit limit______________ Contact person_________________________ 2. Name____________________________________________________________ Address__________________________________________________________ Phone____________________ Account #_______________________________ Credit limit______________ Contact person_________________________ 3. Name____________________________________________________________ Address__________________________________________________________ Phone______________________ Account #_____________________________ Credit limit______________ Contact person_________________________ Bank Information Name____________________________________________________________ Address__________________________________________________________ Phone_________________________ Account #__________________________ Contact person_____________________________________________________ Do you currently have bank financing?________ If yes, account #____________ Amount of loan__________________ Structure of repayment_______________ What assets are securing this loan?_____________________________________ Accountant Information Name____________________________________________________________ Address__________________________________________________________ Phone____________________________________________________________ Is your business current on all local, state and federal taxes?_________________ If no, explain______________________________________________________ _________________________________________________________________ Attorney Information Name____________________________________________________________ Address__________________________________________________________ Phone____________________________________________________________ Insurance Information Name____________________________________________________________ Address__________________________________________________________ Phone____________________________________________________________ SBDC Business Advisor Name____________________________________________________________ Phone____________________________________________________________ PERSONAL INFORMATION (This section must be completed on an individual basis for all principals/co-makers) Full name_______________________, ______________________, ___________ Last First Middle Present address ______________________________________________________ Phone _________________________ E-mail ______________________________ Previous address _____________________________________________________ Social security number__________- ______- __________ Last grade completed______ Are you currently an enrolled student?____________ Name of school______________________________________________________ Area of study________________________________________________________ Total members in household, including applicant____ Are you the head of household? ___Yes ___No Provide a list of community service involvement activities____________________ ___________________________________________________________________ ___________________________________________________________________ Name of all current dependents Age 1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ 4. _______________________________________________________________ Do you have insurance? ___Yes ___No If yes, what kind and who is the provider?_______________________________ _________________________________________________________________ Present employer_____________________________________________________ Address__________________________________________________________ Supervisor’s name__________________________________________________ Phone____________________________________________________________ Applicant’s current monthly income Applicant’s current monthly expenses Source Amount Creditor Account # Amount Source Amount Creditor Account # Amount Source Amount Creditor Account # Amount Source Amount Creditor Account # Amount PERSONAL REFERENCES Name Address Phone 1. _______________________________________________________________ 2. _______________________________________________________________ 3. _______________________________________________________________ Please list nearest living relatives other than principals/co-makers listed on previous page: (must be over the age of 18) 1. Name: _________________________________________________________ Address: _______________________________________________________ Phone: _________________________________________________________ Relationship: ____________________________________________________ 2. Name: _________________________________________________________ Address: _______________________________________________________ Phone: _________________________________________________________ Relationship: ____________________________________________________ Are you a co-maker, endorser, or guarantor on any loan or contract? If yes, payment amount $______________ Current loan balance_____________ Do you currently have any bills that are more than 30 days past due?____________ If yes, please explain________________________________________________ _________________________________________________________________ Are all of your financial obligations listed? ___Yes ___No Are there any suits or judgments currently pending against you, including possible child support issues?__________________________________________________ ___________________________________________________________________ Have you (or your business) ever filed a petition for bankruptcy or creditor protection? ___________________________________________________________________ Month of filing Year of filing State of filing Are you current on child support? ___Yes ___No Have you ever committed a felony? ___Yes ___No Have you ever had, or currently do you have any judgments pending against you? _____ Yes _____ No. If this is other than a misdemeanor for a driving/parking violation please explain. _____________________________________________________________ _____________________________________________________________ Are you currently on probation? ___Yes ___No If yes, name of probation officer_______________________________________ Expected length of probation period____________________________________ CERTIFICATION The loan applicant herein certified that: · To the best of the applicant’s knowledge and belief, the data presented in this loan application is true and correct, and is provided for the purpose of obtaining or maintaining credit. · The purpose described in this application has been duly, and legally authorized by the applicant. · Upon approval of the funds requested, the applicant is willing and is duly and legally authorized to enter into a legally binding loan commitment and will comply with all of the provisions and conditions of any loan agreement. · The applicant hereby authorizes the Loan Committee, its authorized agent and representatives, to investigate the applicant’s credit worthiness, credit capacity, or business affairs. · The applicant hereby authorizes any person, business, and/or financial institution having information pertaining to the applicant’s credit worthiness credit capacity, or business affairs to release the same to the Loan Review Committee, its authorized agents or representatives. · The applicant agrees to hold harmless the SEED, Corp., its officers, agents, and the SEED, Corp. Loan Review Committee members and their respective organizations form liability as a result of actions and outcomes taken during or after the loan review process. _________________________________ _________________________________ Company Name Company Name _________________________________ _________________________________ By (Applicant’s signature) By (Co-applicant’s signature) _________________________________ _________________________________ Printed Name Printed Name _________________________________ _________________________________ Title Title _________________________________ _________________________________ Date Date Please return this original along with (8) copies of this application: Mail in entirety to: SEED Corp. 501 N Morton Street, Suite 100 Bloomington, IN 47404 CREDIT REPORT AUTHORIZATION AND RELEASE Authorization is hereby granted to SEED Corp. to obtain a standard factual data credit report through a credit reporting agency chosen by SEED Corp. My signature below authorizes the release to the credit-reporting agency a copy of my credit application and authorizes the credit-reporting agency to obtain information regarding my employment, savings accounts, and outstanding credit accounts (mortgage, auto loans, personal loans, charge cards, credit unions, etc.) Authorization is further granted to the reporting agency to use a photo static reproduction of this authorization if necessary to obtain any information regarding the above-mentioned information. Any reproduction of this credit report authorized and release made by reliable means (for example, photocopy or facsimile) is considered an original. 1. ___________________________________________ ____________________ Borrower’s signature Date SSN___________________________ 2. ___________________________________________ ____________________ Borrower’s signature Date SSN___________________________ AFFIDAVIT OF CHILD SUPPORT PAYMENTS Comes now, , after being first sworn upon his/her oath now deposes and says as follows: 1. I am eighteen (18) years of age, I make the following representations on my personal knowledge and I am competent to give the testimony herein. 2. I am not currently delinquent in child support payments. I swear or affirm under the penalties for perjury that the above and foregoing statements are true to the best of my knowledge. 1. ___________________________________________ ____________________ Borrower’s signature Date 2. ___________________________________________ ____________________ Borrower’s signature Date Providing Education and Accessible Financing to Small Businesses
Posted on: Sat, 28 Sep 2013 00:45:49 +0000
Trending Topics
Recently Viewed Topics
© 2015