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LOAN ASSISTANCE QUESTIONNAIRE

Please complete this questionnaire as best you are able. Return this completed questionnaire to our office at GSU SBDC, P.O. Box 3986, Atlanta, GA 30302-3986. After the questionnaire has been reviewed, you will be contacted to discuss your loan application.

(Signature of Person Requesting Service) Date: Name of Applicant: Company Name: Business Mailing Address: City Business Telephone Number: Home Address: City Home Telephone Number: State State

(Date)

Zip

Zip

BUSINESS INFORMATION (Please place an X next to the correct response) Are you currently in business? If no, when is your intended start date? On what date was the business established under its current ownership? Type of Business (specify one) Manufacturing Service Retail Wholesale Other Professional Yes No

Please briefly describe your product or service:

LEGAL STRUCTURE OF BUSINESS (Please place an X next to the correct response) Proprietorship Partnership Corporation Who are the current owners? Name S Corporation Limited Liability Company Percent Ownership

Current number of employees

Current number of minority employees

LOAN INFORMATION (Please place an X next to the correct response) Do you expect to raise money through _____Banks _____Other Lenders or through _____Private Investors? What is the purpose of the loan request? Business Start-up Business Purchase How much money will you be requesting? How much money do you plan on investing in the project? $ How much money have you invested in the project? $ Business Expansion Other (Explain) $

How much money is available from other investors for this project? $ Describe the collateral you plan on pledging for the loan: Collateral Value

BUSINESS FINANCIAL INFORMATION (Please place an X next to the correct response) Can you furnish: Financial Projections (start-up only) Interim Balance Sheet (no more than 45 days old) Interim Profit & Loss Statement (no more than 45 days old) Personal Financial Statement (no more than 45 days old) Past 3 Years Business Tax Returns If no, please explain Yes Yes Yes Yes Yes No No No No No

Are your business taxes including payroll withholding up to date? Who prepares your business financial statements? List all current business debt Company Original Amount Current Balance CPA

Yes _____ Yourself Term Payment

No ____ Other Account Status

PERSONAL FINANCIAL INFORMATION (Please place an X next to the correct response)

Personal credit is one of the most important factors in identifying borrowers that will repay their commercial loans. Most lenders require excellent personal credit in order to qualify for business debt.
How would you rate your personal credit? Excellent Good Fair Yes Poor No

Can you furnish a copy of your personal credit report?

If you do not have a current credit report, you may order one by calling Equifax at (800) 685-1111 or TransUnion at (800) 916-8800 or Experien at (800) 682-7654 Are all your personal income taxes paid and current ? Have you had a bankruptcy, slow payments, liens, or other derogatory items during the past seven years? If yes, please explain Yes Yes No No

Are you willing to personally guarantee the loan?

Yes

No

I am requesting assistance from The University of Georgia Business Outreach Services/Small Business Development Center in preparing a loan application package. I agree to supply all information that may be requested in the preparation process. I understand the Business Outreach Service/Small Business Development Center has no influence on the final lending decision and such decision lies solely with the lending institution. I understand that this assistance and preparation process on behalf of The University of Georgia Business Outreach Service/Small Business Development Center in no way assures approval of the loan request. Signature

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