Contact Name:
Title:
Contact Number:
Email Address:
Type of Loan: Select Type Commercial Mezzanine Construction Land Other (please explain) If other explain:
Loan Amount: Number of Months:
Amortization Type Select Amortization Type Fixed Rate Adjustable Other (please explain) If other explain:
Business Name: Business Type: LLC Corporation Proprietor Partnership
Business Address: City:
State: Access denied for user 'dennistongroup'@'localhost' (using password: NO)Select Your State Zip Code:
Nature of Business: Business Phone #:
Business Fax #: Business Email Address:
If Partnership, Is there Formal Agreement? Yes No
Year Established: Tax ID
State in which business was Organized: Access denied for user 'dennistongroup'@'localhost' (using password: NO)Select Your State
Address: City:
Sq. Footage No. of Units
Legal Description of Subject Property
Year Built Appraised Value
Property Will Be Owner Occupied Non Owner Occupied Loan Purpose: Select Purpose Purchase Construction Refinance Construction Permanent Other (please explain)
If other explain:
Year Acquired Orignal Cost
Amount Liens (a) Present Lot Value
(b) Improvement Cost Total (a+b)
Amount Liens Purpose of Refinance
Describe Improvement Improvement Cost
Title will be held in what name(s)
Manner in which title will be held
Estate will be held in Fee Simple LeaseHold
Source of Down Payments, Settlement Charges, And/Or Subordinate Financing (explain)
Guaranter's Name (include Jr. or Sr. if applicable)
SSN # Phone
Street City
State Access denied for user 'dennistongroup'@'localhost' (using password: NO)Select Your State Zip
Own or Rent Own Rent
If Rent (No. of Years)
If residing at present address for less than 2 years complete the following>
If residing at present address for less than 2 years complete the following
Name SSN #
Home Address Annual Salary
Title % of Ownership
Bank Name
Business Checking (6Mos/AVG Bal) Savings (Current Bal)
Loan(s) Account Number
Please check the box if you have provided the information listed.
Last two years business financial statement or tax return.
Current financial statement of all owners.
Last two years personal tax return of all owners.
Recent tax bill if real estate is to be pledged as collateral.
Copy of appraisal (if available).
Copy of environmental report (if available).
THE INFORMATION YOU PROVIDED ON ALL ACCOMPANYING FINANCIAL STATEMENTS AND SCHEDULES IS PROVIDED FOR THE PURPOSE OF OBTAINING CREDIT FOR THE APPLICANT(S) OR FOR THE PURPOSE OF APPLICANT(S) GUARANTEEING CREDIT FOR OTHERS. APPLICANT(S) ACKNOWLEDGED THAT REPRESENTATION MADE IN THIS STATEMENT WILL BE RELIED UPON BY CREDITORS IN ITS DECISION TO GRANT SUCH CREDIT. THIS STATEMENT IS TRUE AND CORRECT AND ACCURATELY REPRESENTS THE FINANCIAL CONDITION OF THE APPLICANT(S) ON THE DATE GEVEN BELOW. THE CREDITOR IS AUTHORIZED TO MAKE ALL INQUIREIES IT DEEMS NECESSARY TO VERIFY THE ACCURACY OF THE INFORMATION CONTAINED HEREIN AND TO DETERMINE THE CREDITWORTHINESS OF THE APPLICANT(S). THE UNDERSIGNED AUTHORIZE ANY PERSON ON CONSUMER REPORTING AGENCY TO GIVE YOU ANY INFORMATION IT MAY HAVE ON THE UNDERSIGNED. APPLICANT(S) ARE AWARE THAT ANY KNOWING OR WILLFUL FASLE STATEMENT REGARDING THE VALUE OF THE ABOVE PROPERTY FOR PURPOSE OF INFLUENCING THE ACTION OF CREDITOR CAN BE A VIOLATION OF FEDERAL LAWS.
APPLICANT(S) FURTHER AUTHORIZE THE BANK TO MAKE SUCH INQUIRIES OF THE VENDORS AS THEY DEEM RESPONSIBLE AND APPROPRIATE.
BY SIGNING BELOW, EACH APPLICANT DECLARES THAT HE/SHE HAS READ AND UNDERSTANDS THE STATEMENT ABOVE.
Signature 1 Date 1
Signature 2 Date 2
Signature 3 Date 3
Signature 4 Date 4
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