AgAmerica Lending Raw Development Land Loan Application

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1 AgAmerica Lending Raw Development Land Loan Application Principal Borrower Loan Terms Loan Amount Requested Term in Years Requested Interest Rate Security Acres County State Legal Description: Additional Security (Include federal & state grazing leases, irrigation equipment, water rights & other equipment necessary to the operation of the security): Description of property and improvements: Title is/will be vested in: The proceeds of the loan will be used as follows: These questions apply to all applicants. If yes to any, please explain. Are any assets pledged as security for debts of others? Have you had a bankruptcy? (past 7 years) Do you have any judgments against you? Are you a party to any lawsuit? Do you have any contingent liabilities? Have you endorsed or guaranteed notes for others? Are you obligated to pay alimony or support? Total Property foreclosed or deed in lieu? (past 7 years)

2 Describe any labor performed, materials furnished or contracts made in connection with the erection or alteration or other improvements on the offered security within the past six months: List all leases on the security, including lessees, amounts, property leased and the lease expiration s: Summarize your exit strategy pertaining to this loan: Agreement The undersigned applicants apply for the loan indicated on this application to be secured by a first mortgage or deed of trust on the property described herein. All persons and companies owning an interest in the property will sign all loan documents required by AgAmerica Lending (Lender) for closing. Applicant represents that it has no claims against, or defenses to obligations owing by applicant to Lender or its affiliates or waives all such claims and defenses to the extent allowed by law. This provision is subject to claims for performance of express contractual obligation owing to applicant by Lender or its affiliates. All disagreements arising as a result of this application or processing of the application shall be resolved by binding arbitration in accordance with Commercial Arbitration Rules of the American Arbitration Association. Everything stated in the application is true and correct to the best of my knowledge. Lender will retain this application whether or not it is approved. Lender is authorized to check credit and employment history and answer questions about my credit experience with Lender. Federal law requires all financial institutions to obtain, verify and record information that identifies each person who applies for a loan. Your name, address, of and other information used to identify you will be verified. You may also be asked to provide your driver's license or other identifying documents prior to closing your loan. Lender will require the reconveyance, termination or subordination of any junior lien holders, leases, or other liens as considered by the Lender neccessary in perfecting its security position. All improvements presently and hereafter attached to the real estate are and will be part of the security. Applicant will carry hazard insurance on the improvements in an amount satisfactory to the lender and with a loss payable clause in favor of U. S. Bank National Association as Custodian/Trustee. Applicant is required to pay all fees, taxes and expenses in connection with closing the loan including title and escrow fees, credit report, UCC search, appraisal, attorney fees, and the cost of preparation, filing and recording of all loan documents. Applicant is required to pay all pairoff fees on loans that are rate locked with AgAmerica Lending and not closed. All applicants must sign &

3 Balance Sheet - Market Basis Statement of : Signature Date: Signature ASSETS Amount LIABILITIES Amount CURRENT ASSETS CURRENT LIABILITIES Cash in Banks Notes Payable/Revolving Debt Balances: Cash Value Life Insurance Marketable Bonds & Securities Retirement Accounts Other Current Liabilities: Other Current Assets: Total Current Assets NON-CURRENT ASSETS Equipment and Vehicles: Total Current Liabilities Real Estate Mortgages: NON-CURRENT LIABILITIES Other Investments/Livestock: Other Non-Current Liabilities: Notes and Contracts Receivable Real Estate Owned Total Non-Current Liabilities Total Liabilities Net Worth Total Liabilities & Net Worth Total Real Estate Owned Total Non-Current Assets Total Assets

4 AgAmerica Lending Borrower's Authorization and Certification Borrower's Authorization to Release Information To Whom It May Concern, 1) I/We have applied for a mortgage loan from AgAmerica Lending. As part of the application process, AgAmerica Lending may verify information contained in my/our loan application and in other documents required in connection with the loan, either before the loan is closed or as part of its quality control program. 2) I/We authorize you to provide AgAmerica, or to any investor to whom AgAmerica may sell my mortgage, any and all information and documentation that they request. Such information includes, but is not limited to: employment history and income; bank, money market, and similar account balance; credit history; and copies of income tax returns. Furthermore, AgAmerica or any investor that purchases the mortgage, may address this authorization to any party named in the loan application. 3) A copy of this signed authorization may be accepted as an original. 4) Your prompt reply to AgAmerica, or the investor that purchased the mortgage, is appreciated. 5) I further authorize AgAmerica to order a consumer credit report and verify other credit or liability information including past and present mortgages and landlord references. It is understood that a photocopy of this form will serve as authorization. 6) The information obtained by AgAmerica to this authorization may be used only for processing my mortgage loan application. Borrower's Certification The undersigned certifies the following: 1) I/We have applied for a mortgage loan from AgAmerica. In applying for the loan, I/we have completed a loan application containing various information on the purpose of the loan, the amount and source of the down payment, employment and income information, and assets and liabilities. I/We certify that the information in the application is true and correct. I/We, as of the set forth opposite my/our signature on the application, made no misrepresentations in the loan application or other documents, nor did I/we omit any pertinent information. Furthermore, I/we fully understand that I/we have a continuing obligation to amend and/or supplement the information provided in the loan application if any of the material facts which have been represented should change prior to closing. 2) If the loan is an alternate documentation mortgage, I/we understand and agree that AgAmerica reserves the right to change the mortgage loan review process to a full documentation program. This may include verifying the information provided on the application with the employer and/or financial institution. 3) I/We fully understand that any intentional or negligent misrepresentation(s) of the information contained in the application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on the application.

5 4) I/We fully understand that my/our original loan application may be retained by AgAmerica, even if the loan is not approved. Borrower's Signature Date Borrower's Printed Social Security Number Date of Birth Home Address: Borrower's Signature Date Borrower's Printed Social Security Number Date of Birth Home Address:

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