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Business Contact Info
Legal Name of Business or Personal Name
Contact Person
Email Address
Physical Address
Street
City
State
Zip
Mailing address is different
Mailing Address (if different)
Street
City
State
Zip
Phone
Fax
Business Tax ID
Business Type
C-Corp
S-Corp
Sole Prop
LLP
LLC
Other
Industry Type
Manufacturer
Service
Retail
Rental
Wholesale
Other
Business Start Date
# of Employees
Property Status
Own
Lease
Monthly Payment
Years at Current Location
Ownership Info
Name of Owner/Partner/Officer
% Ownership
Percentage of ownership.
Title
Social Security #
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Credit Request Summary
Amount
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Purpose
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Source of Repayment
Enter how you plan to repay.
Personal Financial Statement
Statement Date
Applicant Information
Name
SSN
Occupation
Years in Occupation
Physical Address
Street
City
State
Zip
Mailing address is different
Mailing Address (if different)
Street
City
State
Zip
Business Phone
Cell Phone
Co-Applicant Information (if applicable)
Name
SSN
Occupation
Years in Occupation
Physical Address
Street
City
State
Zip
Mailing address is different
Mailing Address (if different)
Street
City
State
Zip
Business Phone
Cell Phone
◆ Schedule A - Cash & Location of Bank Accounts
Account Type
Checking
CD
Saving
Institution/Bank
Institution where located
Name on Account
Balance
Interest Paid to You
Date CD Matures
Account Pledged
Yes
No
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◆ Schedule B - Stocks & Bonds
Description
Please enter a description of the stock or bond.
Type
Select…
Marketable Resources
401K, IRA, OTHER
Other Retirement
Please select a type
# of Shares
Please enter the number of shares.
Registered Name
Date of Valuation
Price per Share
Total Value
Margin or Pledged
Yes
No
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◆ Schedule C - Life Insurance
Insured
Beneficiary
Name of Company
Face Amount
Cash Value
Loans on Policy
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◆ Schedule D - Real Estate Owned
Property Address
% Owned
Please enter the percentage owned.
Type
Select…
Residence
Income Property
Unimproved Land
Other
Value
Monthly Income
Monthly Payment
Loan Balance
Payable to Whom
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◆ Schedule E - Other Assets & Personal Property
Type
Select…
Automobile
RV & Boats
Furniture
Equipment
Jewelry
Other
Year
Make / Model (if applicable)
For vehicles
Description
Value
Loan Balance
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◆ Schedule F - Accounts, Loans & Notes Payable
Type
Select…
Other Institutions
Credit Cards
Revolving Accounts
Other
Payable to Whom
Please enter the name of the creditor.
Collateral
Name on Acct
Maturity Date
Balance Due
Loan Balance
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Accounts & Notes Receivable
Other Liabilities
Income / Expense Statements
Annual Income
Salaries & Wages
Rental Income
Dividends & Interest
Net Business Income
Other Income
Total Income:
------
Annual Expenses
Property Tax Assessment
Federal & State Income Tax
Real Estate Loan Payments
Payments on Contracts
Living Expenses
Other Expenses
Contingent Liabilities
Endorser on Notes
Guarantor on Notes
Taxes
Other Contingent
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