application

General Information

First Name			:
Middle Name			:
Last Name			:
Home Address			:
City	:				State	:
Zip	:
Home Phone	:				Alternate Phone	:

Business Information

Name		:
Address :		:
City		:			State	:
Zip		:			Phone	:
Fax		:			Email	:
Yrs. in Bus.		:			EIN No	:
Annual Gross Revenue		:			Monthly Gross Revenue	:

Loan Information

Type of Loan :				:
Amount of Loan Request				:	$
Term of Loan Request				:	Years
Purpose of Loan				:

Type of Collateral				:	Comm. Real Estate		Equipment
					Private Real Estate		Inventory
					Invoices		None
Age of Property / Business				:	Years
Is property of Business profitable					Yes		No
Amount of Current property / Business Loans				:	$
Lender				:
Entity requesting loan is :				:

Property Information

Property Type				:
Number of Units				:
Number of Units Occupied				:
Description of Building				:
Appraised Value of Property / Collateral				:
Amount of Down Payment				:
Property of Address of Collateral				:
Gross Rentable area				:	Sq. Ft.
Age of Building				:	Years
Gross Income of Property				:

Borrower Information

Borrower No 1
Name				:
Title				:
Annual Income				:
Credit Score is				:
Net Worth of Borrower				:	$
Dunn & Bradstreet Pay Index Score				:

Borrower No 2
Name				:
Title				:
Annual Income				:
Credit Score is				:
Net Worth of Borrower				:	$