MSUFCU Business Loan Application

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1 MSUFCU Business Loan Application Section 1 - Credit Requested Total Funds Needed Less Funds Provided by You - ( ) Less Funds Provided by Others - ( ) Total Loan Needed Section 2 - Business Information Term of Loan Requested How will the funds be used? 3777 West Road, PO Box 1208 East Lansing, MI Phone: Fax: Loan Type Applicant Company Company Legal Name DBA/Franchise Name (if applicable) Phone Fax Website Company Company Mailing Address City State ZIP Principal Office Address (if not listed above) City State ZIP Federal Tax ID Number Description of Business (SIC or NAICS code) Business Structure Individual(s) Limited Partnership C Corporation Sole Proprietorship Limited Liability Partnership S Corporation General Partnership Limited Liability Company Unincorporated Association State of Organization County Date Company Founded Date of Ownership Type of Business Service Wholesale Distribution Retail Manufacturing Other Number of Locations Number of Employees Section 3 - Primary Contact Name Office Phone Mobile Phone Section 4 - Company Ownership List below all owners, partners, Limited Liability Company (LLC) members and stockholders totaling 100 of ownership. Name Address Ownership Social Security Number 1 of 8

2 Section 4 - Company Ownership (Continued) List below all owners, partners, Limited Liability Company (LLC) members, and stockholders totaling 100 of ownership. Name Address Ownership Social Security Number Section 5 - Affiliates Total: (should add to 100) List below all business concerns in which the applicant s company or any of the individuals listed in the Ownership Section above have ownership or controlling interest. Affiliation also exists where an individual(s) has control of the company and other concerns even though the ownership is less than 20. Use additional sheet if necessary. Company Name Owned by # of Employees Ownership Company Name Owned by # of Employees Ownership Company Name Owned by # of Employees Ownership Company Name Owned by # of Employees Ownership Section 6 - Schedule of Business Debt (Use Additional Sheet if Necessary) Original Amount Balance Monthly Payment Rate Lender Loan Number Phone Number Fixed Variable Collateral Original Date Maturity Date Original Amount Balance Monthly Payment Rate Lender Loan Number Phone Number Fixed Variable Collateral Original Date Maturity Date Original Amount Balance Monthly Payment Rate Lender Loan Number Phone Number Fixed Variable Collateral Original Date Maturity Date 2 of 8

3 Section 7 - Collateral Offered by This Applicant (Use Additional Sheet if Necessary) Description Value Total Liens Ownership Status for This Applicant Section 8 - Other Information Any unsettled lawsuits, judgments, or disputes? Yes No Creditor Name If yes, when, what, and why? Section 9 - Authorized Signers for This Applicant (Use Additional Sheet if Necessary) Name Title Date of Birth SSN# Name Title Date of Birth SSN# Name Title Date of Birth SSN# Name Title Date of Birth SSN# Section 10 - Professional Services Accounting Firm Contact Name Phone Law Firm Contact Name Phone Insurance Agency Contact Name Phone 3 of 8

4 Applicant Signatures I/We hereby apply for the loan or credit described in this application on behalf of the applicant business. I/We certify that I/we made no misrepresentation in this loan application or in any related documents, including Federal Income Tax Returns, that all information is true and complete, and that I/we did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. MSUFCU is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by MSUFCU for that purpose. MSUFCU may disclose to any other interested parties information as to MSUFCU s experiences or transactions with my/our account. I/We understand that MSUFCU will retain this application and any other credit information MSUFCU receives, even if no loan or credit is granted. These representations and authorizations extend not only to MSUFCU, but also to any insurer of the loan and to any investor to whom MSUFCU may sell all or part of the loan. I/We further authorize MSUFCU to provide any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan. 4 of 8

5 Personal Financial Statement Company Name: Complete this form for: 1) Each proprietor 2) Each limited partner/general partner if ownership is 20 or more 3) Each stockholder if ownership is 20 or more 4) Any person or entity providing a guaranty on the loan 3777 West Road, PO Box 1208 East Lansing, MI Phone: Fax: Personal Information Applicant Name Spouse Name (if co-borrower or guarantor) Employer City State ZIP Employer Address City State ZIP Business Phone Number Title / Position Number of Years with Employer Name of Previous Employer & Position (if with current employer less than 3 years) Number of Years Home Home / Cell Phone SSN# Date of Birth Name and Phone Number of Your Accountant Name and Phone Number of Your Attorney Name and Phone Number of Your Investment Advisor/Broker Name and Phone Number of Your Insurance Advisor Applicant - Sources of Annual Income Salary (amount reported on W-2) or Professional Net Income Bonuses and Commissions Interest and Dividends Alimony, Child Support and Separate Maintenance Payments* Net Real Estate Income Other Income Describe Total Annual Income * Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. General Information Are you a defendant in any suit or legal action? _Yes _No If yes, please explain: Are you presently subject to any unsatisfied judgments or tax liens? _Yes _No If yes, please explain: 5 of 8

6 Applicant - Information Concerning Will Date of Will No Will No Executor Have you ever been through bankruptcy or settled any debts for less than amount owed? Yes No If yes, explain: Have you filed Federal Tax Returns for the most recent year? Yes No Have you paid all related taxes? Yes No Dates of last IRS Audit Assets Amount Liabilities Amount Cash on Hand and in Financial Institutions Notes Payable to Banks Secured (Schedule D) Savings Notes Payable to Banks Unsecured (Schedule E) IRA or Other Retirement Auto Loans and Leases (Schedule F) Life Insurance: Cash Surrender Value (Schedule A) Amounts Payable to Others (Schedule G) Stocks and Bonds (Schedule B) Credit Cards (Schedule H) Real Estate Owned (Schedule C) Unpaid Income Tax Personal Property Other Unpaid Taxes and Interest Automobiles - Present Value Real Estate Mortgages Payable Net Worth of Business Owned Other Debts - Itemize Other Assets - Itemize TOTAL ASSETS TOTAL LIABILITIES NET WORTH (N/W) TOTAL LIABILITIES AND N/W Schedules A-H Schedule A - Life Insurance Carried (Specify Term, Whole, Universal Insurance) Face Amount Name of Company Beneficiary Cash Surrender Value Loans Policy # 6 of 8

7 Schedule B - Stocks and Bonds # Shares or Face Value (Bonds) Description In the Name of Market Value Schedule C - Real Estate Owned List each parcel separately. Use additional sheet if necessary. Each attachment must be identified as part of this statement and signed. Type of Property Address Property A Property B Property C Date Purchased Original Cost Present Market Value Name and Address of Mortgage Holder Mortgage Account Number Mortgage Balance Amount of Payment per Month/Year Status of Mortgage: or Past Due Type: 1st Mortgage Home Equity LOC, other Schedule D - Notes Payable to Financial Institutions (Secured) Noteholder Name Address Collateral Original Amount Monthly Payment Balance Past Due 7 of 8

8 Schedule E - Notes Payable to Financial Institutions (Unsecured) Noteholder Name Address Original Amount Monthly Payment Balance Past Due Schedule F - Auto Loans and Leases Noteholder Name Address Vehicle Make and Model Original Amount Monthly Payment Balance Past Due Schedule G - Amounts Payable to Others Noteholder Name Address Collateral Original Amount Monthly Payment Balance Past Due Schedule H - Credit Cards Name Date Credit Limit Owe ly Secured or Unsecured I authorize MSUFCU to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify below that the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. The undersigned certifies that both sides hereof and the information inserted therein has been carefully read and is true, correct and complete. Name (printed): Name (printed): Signature: Signature : Date: Date: Use additional schedules when necessary. 8 of 8

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