New Loan

Borrower Information

Borrower Information Tell Us About Business

Company Legal Name

Type of Business

Physical Address

Address 2

City

State

Zip Code

Mailing Address

Address 2

City

State

Zip Code

Tax Id

Business Email

Phone Number

Loan Request

Amount Of Request ($)

Loan Request Type

Purpose of Loan Request

Collateral

General Information

Are all of Company’s tax filings up to date?

Are any of the Company’s assets pledged?

Is the Company or any if its owners/members involved in any pending legal actions?

Does the Company have any obligations past due?

Have either you, Company, or any business entity which you are greater than 20% owner ever declared bankruptcy?

Is the Company presently subject to unsatisfied judgments or tax liens?

Has the Company ever been audited by the IRS?

If so, when?

Have you, Company, or any business entity of which you were major owner ever been convicted of any criminal offense other than a minor motor vehicle violation?

Owner/Guarantor Information

Guarantor Information All individuals and entities with an ownership interest of 20% or greater are required to personally guarantee the loan

Is there any person or entity that has ownership of 20% or more in the Borrower?

Name (Business or Individuals Name)

Physical Address

Address 2

City

State

Zip Code

TIN/Social Security Number

Date of Birth for Individuals OR Date Company Formed

Phone Number

% Ownership

Email Address

Name (Business or Individuals Name)

Physical Address

Address 2

City

State

Zip Code

TIN/Social Security Number

Date of Birth for Individuals OR Date Company Formed

Phone Number

% Ownership

Email Address

Name (Business or Individuals Name)

Physical Address

Address 2

City

State

Zip Code

TIN/Social Security Number

Date of Birth for Individuals OR Date Company Formed

Phone Number

% Ownership

Email Address

Name (Business or Individuals Name)

Physical Address

Address 2

City

State

Zip Code

TIN/Social Security Number

Date of Birth for Individuals OR Date Company Formed

Phone Number

% Ownership

Email Address

Add Guarantor

Agreement

Agreement Agreement of Borrower and Owner/Personal Guarantor(s)/Company Guarantor(s)

This authorization is valid for purposes of verifying information given pursuant to employment, leasing, rental, business negotiations, or any other lawful purpose covered under the Fair Credit Reporting Act. (FCRA) The Background Check may contain information available in the Public Domain but may not include interviews with persons other than previous employers or their agents. By my signature below, I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts and agencies, military services and persons to release all information they may have about me including criminal and driving history. This authorization shall be valid in original or copy form.

By clicking this Box, you agree to the terms described above.

Please select consent checkbox.

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