Business Loan Application Form - Members Choice Credit Union

ADVERTISEMENT
INFORMATION REQUEST CHECKLIST
Required Items
PERSONAL INFORMATION
Last 3 Years Personal Tax Returns on all persons owning 20% or more of applicant
business
Personal Financial Statement on all persons owning 20% or more of applicant business
(form enclosed)
Form 912 on all persons owning 20% or more of applicant business
(form enclosed)
Form 912 on all spouses of persons owning 20% or more of applicant business
(form enclosed)
APPLICANT BUSINESS INFORMATION
Last Three Years Business/Corporate Tax Returns on applicant business
Last Three Years Fiscal Year End Financial Statements on applicant business
Current Interim Financial Statement on applicant business (must be dated within 60
days)
Schedule of Fixed Debt on applicant business (form enclosed)
Copies of any and all notes to be refinanced
One Year Sales & Expense Projections (form enclosed) Must include assumptions
History of applicant business (form enclosed)
Listing of accounts payable and accounts receivable
REAL ESTATE/EQUIPMENT INFORMATION
Copy of real estate earnest money contract
Estimates of any proposed Construction/Renovations/Remodeling
Plans, Specifications, and details of any proposed construction
List of machinery, equipment, furniture & fixtures, now owned by applicant business
SELLER’S INFORMATION
Cost breakdown of assets (i.e. real estate, equipment, inventory, goodwill, etc.) being
purchased
List of machinery, equipment, furniture & fixtures, and inventory to be purchased from
seller
Last Three Years Business/Corporate Tax Returns on seller business
Last Three Years Fiscal Year End Financials Statements on seller business
Current Interim Financial Statement on seller business (must be dated within 60 days)
This list may not be an all-inclusive. Additional items may be required
INFORMATION REQUEST CHECKLIST
Required Items
PERSONAL INFORMATION
Last 3 Years Personal Tax Returns on all persons owning 20% or more of applicant
business
Personal Financial Statement on all persons owning 20% or more of applicant business
(form enclosed)
Form 912 on all persons owning 20% or more of applicant business
(form enclosed)
Form 912 on all spouses of persons owning 20% or more of applicant business
(form enclosed)
APPLICANT BUSINESS INFORMATION
Last Three Years Business/Corporate Tax Returns on applicant business
Last Three Years Fiscal Year End Financial Statements on applicant business
Current Interim Financial Statement on applicant business (must be dated within 60
days)
Schedule of Fixed Debt on applicant business (form enclosed)
Copies of any and all notes to be refinanced
One Year Sales & Expense Projections (form enclosed) Must include assumptions
History of applicant business (form enclosed)
Listing of accounts payable and accounts receivable
REAL ESTATE/EQUIPMENT INFORMATION
Copy of real estate earnest money contract
Estimates of any proposed Construction/Renovations/Remodeling
Plans, Specifications, and details of any proposed construction
List of machinery, equipment, furniture & fixtures, now owned by applicant business
SELLER’S INFORMATION
Cost breakdown of assets (i.e. real estate, equipment, inventory, goodwill, etc.) being
purchased
List of machinery, equipment, furniture & fixtures, and inventory to be purchased from
seller
Last Three Years Business/Corporate Tax Returns on seller business
Last Three Years Fiscal Year End Financials Statements on seller business
Current Interim Financial Statement on seller business (must be dated within 60 days)
This list may not be an all-inclusive. Additional items may be required
BUSINESS LOAN
For Credit Union Use Only
Business Account # ______________
APPLICATION
Employee ______________________
I. GENERAL BUSINESS INFORMATION
†Borrower Name: ________________________________________
Date of Organization:
_____________
DBA Name: ________________________________________
Federal Tax ID# (EIN): _____________
Business Physical Address (No P.O. Boxes):
Mailing Address (if different):
Street _________________________________________
Street _________________________________________
City _________________
State ____
ZIP _______
City _________________
State ____
ZIP _______
Business Phone:
(____)_____________
Business Fax:
(____)_____________
Industry Type
Wholesale
Construction
Number of Employees:
Before Loan____ After Loan____
(mark only one):
Retail/Service
Manufacturing
Describe the primary nature of your business and its products or services: ___________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Is this business a franchise?
Yes
No
Is this business for profit?
Yes
No
Does this business restrict patronage?
Yes
No
Does the borrower or a principal of the borrower have controlling interest in any other business?
Yes
No
*
Does the borrower or a principal of the borrower have any outstanding SBA loans?
Yes
No
**
Describe the purpose of this loan and how it will benefit your business: ______________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
The following section relates to your planned use for the funds from this loan request
II. USE OF LOAN PROCEEDS
Please be as accurate and specific as possible in breaking out anticipated expenditures by category
Project Items
Project Cost
Land & Building Acquisition
$ _________________
Land Acquisition
$ _________________
Building Construction / Improvement (Hard Costs)
$ _________________
Building Construction / Improvement (Soft Costs)
$ _________________
Debt Refinance (Complete section III below)
$ _________________
Business Acquisition (List of assets & purchase agreement required)
$ _________________
Machinery / Equipment Acquisition
$ _________________
Inventory
$ _________________
Furniture
$ _________________
Fixtures
$ _________________
Working Capital
$ _________________
Other (Describe):
___________________________________________________
$ _________________
Total Project Cost:
$ _________________
0.00
Less Borrower’s Injection:
$ _________________
Source of Injection: ___________________________________________________
(Enter negative number)
Total Loan Request:
$ _________________
0.00
Business Loan Application v.1/09
© 2009 R. Kent Moon
1
Used by Permission of Copyright Owner
A copy of all promissory notes and commercial security agreements,
III. FOR DEBT REFINANCE
with per diem payoff quotes are required
(attach additional sheets if more space is required)
Outstanding
Loan Maturity
Creditor Name
Monthly Payment
Interest Rate
Balance
(Month/Year)
$
$
%
$
$
%
$
$
%
$
$
%
$
$
%
Please provide a detailed written explanation for each affirmative response
IV. CONFLICT OF INTEREST
(Explanations must be attached on a separate sheet)
Is the borrower or a principal of the borrower immediately related to any or an employee of any of the following?
A. Lending organization or its affiliates?
Yes
No
B. U.S. Small Business Administration
Yes
No
C. Small Business Administration Associates, Community Organizations or Programs?
Yes
No
D. Member of the United States military with a rank of Major, Lieutenant Commander, or higher?
Yes
No
E. Federal employee with a GS-13 clearance level or higher?
Yes
No
F. Federal Senate or House of Representatives?
Yes
No
G. Appointed officials of: Federal Judiciary, Senate or House of Representatives?
Yes
No
Owner(s), General Partner(s), Managing Member(s), or Officer(s)
V. GENERAL PRINCIPAL INFORMATION
Any Person(s) with 20% or more ownership in the borrower must be listed
1) First Name:__________________________________
M.I.: ______
Last Name:_____________________________________
SSN:_________________
Date of Birth: _________
Title:_________________________________
Ownership %: _________
Residence Physical Address (No P.O. Boxes):
Street _________________________________________
Are you a United States citizen?
Yes
Noºº
City _________________
State ____
ZIP_______
Are you a veteran of the United States Armed Forces?
Yesº
No
Residence Phone:
(____)_____________
Have you ever declared bankruptcy?
Yes
No
Mobile Phone:
(____)_____________
Are you currently involved in any lawsuits/litigations?
Yes
No
Monthly child support/alimony payment:
$_______ Are you past due on any tax obligations?
Yes
No
Email Address:__________________________________
Have you ever defaulted on any Federally assisted loan?
Yes
No
2) First Name:__________________________________
M.I.: ______
Last Name:_____________________________________
SSN:_________________
Date of Birth: _________
Title:_________________________________
Ownership %: _________
Residence Physical Address (No P.O. Boxes):
Street _________________________________________
Are you a United States citizen?
Yes
Noºº
City _________________
State ____
ZIP_______
Are you a veteran of the United States Armed Forces?
Yesº
No
Residence Phone:
(____)_____________
Have you ever declared bankruptcy?
Yes
No
Mobile Phone:
(____)_____________
Are you currently involved in any lawsuits/litigations?
Yes
No
Monthly child support/alimony payment:
$_______ Are you past due on any tax obligations?
Yes
No
Email Address:__________________________________
Have you ever defaulted on any Federally assisted loan?
Yes
No
3) First Name:__________________________________
M.I.: ______
Last Name:_____________________________________
SSN:_________________
Date of Birth: _________
Title:_________________________________
Ownership %: _________
Residence Physical Address (No P.O. Boxes):
Street _________________________________________
Are you a United States citizen?
Yes
Noºº
City _________________
State ____
ZIP_______
Are you a veteran of the United States Armed Forces?
Yesº
No
Residence Phone:
(____)_____________
Have you ever declared bankruptcy?
Yes
No
Mobile Phone:
(____)_____________
Are you currently involved in any lawsuits/litigations?
Yes
No
Monthly child support/alimony payment:
$_______ Are you past due on any tax obligations?
Yes
No
_____________________________________________
Email Address:__________________________________
Have you ever defaulted on any Federally assisted loan?
Yes
No
Title:_________________
Ownership %: _______
Date of Birth:_________
Place of Birth: _________________________
_____________
Business Loan Application v.1/09
© 2009 R. Kent Moon
2
Used by Permission of Copyright Owner
All items must be completed, if an item is not applicable, please so indicate
VI. MANAGEMENT RESUME
(attach additional sheets if more space is required)
Legal Name: ___________________________________
Residence Physical Address (No P.O. Boxes):
Previous Residence Address:
Street _________________________________________
Street _________________________________________
City _________________
State ____
ZIP _______
City _________________
State ____
ZIP _______
Residence Phone:
(____)_____________
Lived there from:_____________
to:_____________
College or Technical Training
A. EDUCATION
(list most recent degree first)
Name of Institution:_____________________________________________
Location:__________________
Degree/Certificate: ___________________________
Dates Attended: from:__________ to:__________
Major: ___________________________
Name of Institution:_____________________________________________
Location:__________________
Degree/Certificate: ___________________________
Dates Attended: from:__________ to:__________
Major: ___________________________
Name of Institution:_____________________________________________
Location:__________________
Degree/Certificate: ___________________________
Dates Attended: from:__________ to:__________
Major: ___________________________
Please provide a short narrative of skills related to the primary industry of your business
B. SKILLS
(attach additional sheets if more space is required)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Please provide a short narrative of duties and responsibilities as assigned
C. WORK EXPERIENCE
(list most recent employer first) (attach additional sheets if more space is required)
Name of Company:_____________________________________________
Location: _____________________________
Dates Employed:
from:__________ to:__________
Position / Title: _____________________________
Duties: ___________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Name of Company:_____________________________________________
Location: _____________________________
Dates Employed:
from:__________ to:__________
Position / Title: _____________________________
Duties: ___________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Name of Company:_____________________________________________
Location: _____________________________
Dates Employed:
from:__________ to:__________
Position / Title: _____________________________
Duties: ___________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Business Loan Application v.1/09
© 2009 R. Kent Moon
3-a
Used by Permission of Copyright Owner
All items must be completed, if an item is not applicable, please so indicate
VI. MANAGEMENT RESUME
(attach additional sheets if more space is required)
Legal Name: ___________________________________
Residence Physical Address (No P.O. Boxes):
Previous Residence Address:
Street _________________________________________
Street _________________________________________
City _________________
State ____
ZIP _______
City _________________
State ____
ZIP _______
Residence Phone:
(____)_____________
Lived there from:_____________
to:_____________
College or Technical Training
A. EDUCATION
(list most recent degree first)
Name of Institution:_____________________________________________
Location:__________________
Degree/Certificate: ___________________________
Dates Attended: from:__________ to:__________
Major: ___________________________
Name of Institution:_____________________________________________
Location:__________________
Degree/Certificate: ___________________________
Dates Attended: from:__________ to:__________
Major: ___________________________
Name of Institution:_____________________________________________
Location:__________________
Degree/Certificate: ___________________________
Dates Attended: from:__________ to:__________
Major: ___________________________
Please provide a short narrative of skills related to the primary industry of your business
B. SKILLS
(attach additional sheets if more space is required)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Please provide a short narrative of duties and responsibilities as assigned
C. WORK EXPERIENCE
(list most recent employer first) (attach additional sheets if more space is required)
Name of Company:_____________________________________________
Location: _____________________________
Dates Employed:
from:__________ to:__________
Position / Title: _____________________________
Duties: ___________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Name of Company:_____________________________________________
Location: _____________________________
Dates Employed:
from:__________ to:__________
Position / Title: _____________________________
Duties: ___________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Name of Company:_____________________________________________
Location: _____________________________
Dates Employed:
from:__________ to:__________
Position / Title: _____________________________
Duties: ___________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Business Loan Application v.1/09
© 2009 R. Kent Moon
3-b
Used by Permission of Copyright Owner

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