Business Loan Application

The information in this questionnaire is provided

by the business owner, for the use of
___________________________________________________
In order for us to better understand our business customers and more efficiently process business loan requests,
please complete the following form as completely and accurately as possible. Thank you for providing this information.
Business Name
Employer ID No.

Authorized Signature

Owner's Name:

SSN:

DOB:

Co-Owner's Name:

SSN:

DOB:

Physical Address:

Mailing Address:

City:

State, Zip Code

Business Phone:

Home Phone:

Business Fax:

Cell Phone:

Website:

E-mail Address:

Circle One:

C - Corp

S-Corp

Year Organized:

LLC

Partnership

Other

Fiscal Year End:

We intend to apply for joint credit. (Applicant)________________________ (Joint Applicant)_________________________

NAMES OF ALL BUSINESS OWNERS AND PERCENTAGE OF OWNERSHIP:
Name:

Name:

Name:

Name:

Name:

Name:

Brief History

Circle One:

Manufacturing

Retail

Service

CPA / Accountant:

Address:

Phone Number:

Fax Number:

Professional

E-Mail Address:

Completed By:

(Please print or type name)

Other

Signature:

Date:

n requests,
s information.

___________

TO:
BANK NAME
TYPE OF CREDIT - CHECK THE APPROPRIATE BOX
Individual - If you check this box, provide Financial Information only about yourself.
Joint, with

Relationship

If you check this box, provide Financial Information about both yourself and the other person.

PERSONAL FINANCIAL STATEMENT

NOTE: Any willful misrepresentation could result in a violation of Federal Law (Sec. 18 U.S.C. 1014)
Name:

Name:

Address:

Address:

City/St/Z:

City/St/Z:

Phone:

Phone:

Phone:

Phone:

Statement of Financial Condition as of:

(mm/dd/yyyy)

SECTION I

ASSETS

LIABILITIES

1 Cash on Hand & in Banks

S II-A

$0.00

21 Notes Due to Banks

S II-A

$0.00

2 Cash Value of Life Insurance

S II-B

$0.00

22 Notes Due to Relatives & Friends

S II-H

$0.00

3 US Gov't Securities

S II-C

$0.00

23 Notes Due to Others

S II-H

$0.00

4 Other Marketable Securities

S II-C

$0.00

24 Accounts & Bills Payable

S II-H

$0.00

5 Notes & Accts Receivable - Good

S II-D

$0.00

25 Unpaid Income Taxes Due

$0.00

$0.00

26 Other Unpaid Taxes & Interest

$0.00

6 Other Assets Easily Converted to Cash

7 Itemize:

27 Loans on Life Insurance Policies

S II-B

$0.00

28 Contract Accounts Payable

S II-H

$0.00

29 Cash Rent Owed

$0.00

$0.00

30 Other Liabs Due w/in One Year

$0.00

10 TOTAL CURRENT ASSETS

11 Real Estate Owned

S II-E

$0.00

31

12 Mortgages and Contracts Owned

S II-F

$0.00

32

13 Notes & Accts Receivable - Doubtful

S II-D

$0.00

33 TOTAL CURRENT LIABILITIES

14 Notes Due from Relatives & Friends

S II-D

$0.00

34 Real Estate Mortgages Payable

15 Other Securities - Not Readily Marketable

S II-C

$0.00

35 Liens & Assessments Payable

$0.00

16 Personal Property

S II-G

$0.00

36 Other Debts - Itemize

$0.00

$0.00

37

17 Other Assets - Itemize

18
19
20 TOTAL ASSETS

$0.00

$0.00
S II-E

$0.00

38 Total Liabilities

$0.00

39 Net Worth (Total Assest - Total Liabs)

$0.00

40 TOTAL LIABILITES & NET WORTH

$0.00

ANNUAL INCOME

ESTIMATE OF ANNUAL EXPENSES

Salary, Bonuses & Commissions

$0.00

Income Taxes

$0.00

Dividends and Interest

$0.00

Other Taxes

$0.00

Rental & Lease Income (Net)

$0.00

Insurance Premiums

$0.00

Mortgage Payments

$0.00

Alimony, child support, or separate maintenance income.

(Optional)

$0.00

Rent Payable

$0.00

Other Income - Itemize

$0.00

Other Expenses

$0.00

Other Persons Salary, Bonus & Comm (If applicable)

$0.00

TOTAL

$0.00

Alimony, child support, or separate maintenance income.

(Optional)

$0.00

TOTAL

$0.00

For the purpose of procuring credit from time to time, I/We furnish the foregoing as a true and accurate statement of my/our financial condition.
Authorization is hereby given to the Lender to verify, in any manner it deems appropriate, any and all items indicated on this statement.
The undersigned also agrees to notify the Lender immediately in writing of any significant adverse change in such financial condition.
Date:

Signature:

SSN:

DOB:

Date:

Signature:

SSN:

DOB:

SECTION II
A

CASH IN BANKS AND NOTES DUE TO BANKS

Name of Bank

Type of Account

Cash on Hand

Type of Ownership

On Deposit

TOTALS

$0.00

(Sec 1, Ln 21)

Face Amount

Policy Loan
Cash Surrender Value Insurance Co

Other Loans
Against Policy

$0.00

(Sec 1, Ln 27)

SECURITIES OWNED (Including U.S. Gov't Bonds and all other Stocks and Bonds)
No. of
Shares

Description
(Denote
those not in your name)

Type of
Ownership

Market Value US
Gov't

Cost

TOTALS

Market Value
Marketable Sec

$0.00
(Sec 1, Ln 3)

Market Value NonMarketable Sec

$0.00
(Sec 1, Ln 4)

PCT

When Due

Original
Amount

Balance Due
Good Accounts

TOTALS

Balance Due
Doubtful Accts

$0.00
(Sec 1, Ln 5)

$0.00
(Sec 1, Ln 15)
Bal Due Notes
Relatives/Friends

$0.00
(Sec 1, Ln 13)

Date
Acquired

Description & Location

Original
Cost

TOTAL

Present
Value - RE

$0
(Sec 1, Ln 11)

$0.00
(Sec 1, Ln 14)

Amt Ins.
Carried

Mortgage
Balance

TOTAL

Payment
Amount

Mortgage Holder

$0
(Sec 1, Ln 34)

MORTGAGES AND CONTRACTS OWNED

Indicate whether Mtg or Cont, Maker's Name & Address, Property Covered, Orig. Date, Pmt Amount, Maturity, and Balance Due

Balance Due

TOTAL (To Sec. 1, Line 12)

$0.00

PERSONAL PROPERTY

Indicate Type of Property, Date New, Cost New, Present Value (Sec 1, Line 16), and Balance Due and to whom, if mortgaged.

Present Value

TOTAL (To Sec. 1, Line 16)

Security (If Any)

REAL ESTATE OWNED

Title In Name of

Amount Pledged to
Secure Loans

NOTES AND ACCOUNTS RECEIVABLE (Money Payable or Owed to You Individually)

Maker / Debtor

Beneficiary

$0.00

(Sec 1, Ln 2)

$0.00

(Sec 1, Ln 1)

TOTALS

Collateral & Type of Ownership

LIFE INSURANCE (List only those Policies that you own)

Company

Notes Due Banks

Cash

NOTES

(Other than Bk, Mtg and Ins Co. Lns),

Other Obligor
Payable To
(If Any)
When Due

$0.00

ACCOUNTS AND BILLS AND CONTRACTS PAYABLE

TOTALS

Notes Due
Rels/Friends

$0.00
(Sec 1, Ln 22)

Notes Due
Others, Not Bks

$0.00
(Sec 1, Ln 23)

Accounts & Bills

Payable

$0.00
(Sec 1, Ln 24)

Contracts
Payable

$0.00
(Sec 1, Ln 28)

Collateral (If Any)

n.

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00

ship

ledged to
Loans

(If Any)

Holder

e Due

00
Value

00

(If Any)

BANK NAME
Consumer Name
Consumer Address
Consumer City, State, Zip

Years of Data

PERSONAL TAX RETURN

CASH FLOW STATEMENT

-----------------------------------------------------------------------------------------------------------------------------------------------------------------YEAR
W-2 WAGES
BORROWER - Line 7
CO-BORROWER - Line 7
--------------- --------------- --------------TOTAL W-2 WAGES
--------------- --------------- --------------INTEREST INCOME - Line 8 (a or b)
DIVIDEND INCOME - Line 9(a or b)
TAXABLE REFUNDS - Line 10

2010

2011

2012

2013

2014

AVG.

PRO-FORMA

$
- $
- $
- $
- $
- $
- $
$
- $
- $
- $
- $
- $
- $
------------------ ------------------ ------------------ ------------------ ------------------ ------------------ -----------------$
- $
- $
- $
- $
- $
- $
------------------ ------------------ ------------------ ------------------ ------------------ ------------------ -----------------$
- $
- $
- $
- $
- $
- $
$
- $
- $
- $
- $
- $
- $
$
- $
- $
- $
- $
- $
- $
-

SCHEDULE C
NET INCOME - Line 31
$
- $
- $
- $
- $
- $
- $
DEPRECIATON - Line 13
$
- $
- $
- $
- $
- $
- $
INTEREST - Line 16a + 16b
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ -----------------SCH C CASH FLOW
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ -----------------SCHEDULE D
SHORT-TERM GAINS - Line 3(h)
$
- $
- $
- $
- $
- $
- $
LONG-TERM GAINS - Line 10(h)
$
- $
- $
- $
- $
- $
- $
FORM 4797 - Line 30
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ -------------------- -----------------SCHEDULE E
NET INCOME - Line 26
$
- $
- $
- $
- $
- $
- $
DEPRECIATION - Line 18
$
- $
- $
- $
- $
- $
- $
INTEREST - Line 12 + 13
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ -------------------- -----------------SCHEDULE E CASH FLOW
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ -------------------- -----------------SCHEDULE F
NET INCOME - Line 34
$
- $
- $
- $
- $
- $
- $
DEPRECIATION - Line 14
$
- $
- $
- $
- $
- $
- $
INTEREST - Line 21a + 21b
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ -------------------- -----------------SCHEDULE F CASH FLOW
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ -------------------- -----------------OTHER INCOME - Line 15 + 16
$
- $
- $
- $
- $
- $
- $
OTHER INCOME - Line 19 + 20 + 21
$
- $
- $
- $
- $
- $
- $
OTHER INCOME - K-1 (Sch. E - L 32)
$
- $
- $
- $
- $
- $
- $
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ -------------------- -----------------TOTAL CASH FLOW
$
- $
- $
- $
- $
- $
- $
========== ========== ========== ============ ============ ============ ============ ============ ========================
MONTHLY CASH FLOW
$
- $
- $
- $
- $
- $
- $
YEAR-->
HOUSING EXPENSES
(Per Year)
PERSONAL EXPENSES
(Per Year)
BUSINESS EXPENSES
(Per Year)
--------------- --------------- ---------------

2010

2013

2014

AVG.

PRO-FORMA

---------------

---------------

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

---------------

#DIV/0!
#DIV/0!

--------------------------------------

#DIV/0!
#DIV/0!
#DIV/0!

---------------

#DIV/0!
#DIV/0!

---------------

#DIV/0!
#DIV/0!
#DIV/0!

---------------

#DIV/0!
#DIV/0!

---------------

#DIV/0!
#DIV/0!
#DIV/0!

---------------

#DIV/0!
#DIV/0!

---------------

#DIV/0!
#DIV/0!
#DIV/0!

--------------- --------------- --------------- ---------------

ADJ. PERSONAL DTI (%)

ADJ. DSCR (X)

2012

HOUSING DTI (%)

PERSONAL DTI (%)
DSCR (X)

LIVING EXPENSES

2011

--------------------------------------

#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!

BANK NAME
Corporation Name
Corporation Address
Corporation City, State, Zip

Years of Data

CORPORATE TAX RETURN

CASH FLOW STATEMENT

-----------------------------------------------------------------------------------------------------------------------------------------------------------------YEAR
BALANCE SHEET ($ = $1,000)

2010

2011

2012

2013

2014

AVG.

PRO-FORMA

ASSETS (Line 15)

LIABILITIES (Line 16 thru Line 21)

--------------- --------------- --------------NET WORTH (EQUITY)
--------------- --------------- ---------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

2010

2011

2012

2013

2014

AVG.

PRO-FORMA

YEAR

INCOME STMT. ($ = $1,000)

Sales / Revenue
Gross Sales (Line 1)

Cost of Goods Sold (Line 2)

Other Income

(Line 5)

Other Loss (Line 5)

--------------- --------------- --------------GROSS PROFIT
--------------- --------------- ---------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

Depreciation Expense (Line 14)

All Other Expense (Calculated)

Operating/Administrative Expense
Interest Expense

(Line 13)

--------------- --------------- --------------TOTAL EXPENSE (Line 20)

--------------- --------------- ---------------

-----------------$
------------------

-----------------$
------------------

-----------------$
------------------

-----------------$
------------------

-----------------$
------------------

-------------------- -----------------$
$
-------------------- ------------------

--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ -------------------- -----------------TOTAL NET INCOME
$
$
$
$
$
$
$
========== ========== ========== ============ ============ ============ ============ ============ ========================

BANK NAME
Corporation Name
Consumer Name
Consumer Name # 2

Years of Data

GLOBAL
CASH FLOW STATEMENT

-----------------------------------------------------------------------------------------------------------------------------------------------------------------YEAR

2010

2011

2012

2013

2014

AVG.

PRO-FORMA

INTEREST EXPENSE
--------------- --------------- --------------EBITDA
--------------- --------------- ---------------

$
$
$
-----------------$
------------------

$
$
$
-----------------$
------------------

$
$
$
-----------------$
------------------

$
$
$
-----------------$
------------------

$
$
$
-----------------$
------------------

$
$
$
-----------------$
------------------

$
$
$
-----------------$
------------------

Business Expenses

--------------- --------------- --------------DEBT SERVICE COVERAGE

--------------- --------------- ---------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

2010

2011

2012

2013

2014

AVG.

PRO-FORMA

NET INCOME
--------------- --------------- --------------EBITDA
--------------- --------------- ---------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

Housing Expenses
Personal Expenses

$
$

$
$

$
$

$
$

$
$

$
$

$
$

--------------- --------------- --------------DEBT SERVICE COVERAGE

--------------- --------------- ---------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

-----------------#DIV/0!
------------------

2010

2011

2012

2013

2014

AVG.

PRO-FORMA

NET INCOME
--------------- --------------- --------------EBITDA
--------------- --------------- ---------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

$
-----------------$
------------------

Personal Expenses
Business Expenses

$
$

$
$

$
$

$
$

$
$

$
$

$
$

CORPORATION
Corporation Name
NET INCOME
DEPRECIATION EXPENSE

YEAR

------------------ -----------------#DIV/0!
#DIV/0!
------------------ ------------------

PERSONAL
Consumer Name

YEAR

------------------ -----------------#DIV/0!
#DIV/0!
------------------ ------------------

PERSONAL
Consumer Name # 2

--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ -----------------DEBT SERVICE COVERAGE
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
--------------- --------------- --------------- ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ -----------------Global Cash Flow Available
$
$
$
$
$
$
$
Global Debt Service Requirement
$
$
$
$
$
$
$
GLOBAL DSC RATIO
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
========== ========== ========== ============ ============ ============ ============ ============ ========================
Living Expenses
$
$
$
$
$
$
$
GLOBAL Net DSC RATIO
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
========== ========== ========== ============ ============ ============ ============ ============ ========================

BANK NAME

Date

Date

Cash Flow & Debt to Income Analysis

Non Complex Income Sources - Consumer Purpose Loans

Borrower:

Verification & Source:

Credit
Score

Years
On Job

Years
at. Res.

Borrower Name
Co-Borrower Name

Total Gross Monthly Income

Total Gross Annual Income

(A)
(A)
$
Current

Monthly Payments and Terms:

M/L PMTS ( P & I) or Rent Payments
M/L Taxes
M/L Insurance
Total Real Estate Outlay

Proposed Payments:
Proposed Payments:
Proposed Payments:
Total Monthly Payments
Total Annual Payments
Maximum Real Estate DTI = 25% (B / A)
Maximum Total DTI = 40% (C / A)
Maximum Total DTI (incl. Living Expenses) = 60%
Notes RE: Loan Request or Calculations:
Comments:

(C)
(C)

$
$

100.00%
100.00%

$
Proposed

$0
$0
$0
(B)

$
$

#DIV/0!

$
$
$

$
$
$

$
$
$

$0 #DIV/0!
$0 #DIV/0!

#DIV/0!

$0 #DIV/0!
$0 #DIV/0!