Loan Submission Packet

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1 Loan Submission Packet Old National Structured Finance 2723 South State Street Suite 210 Ann Arbor, MI oldnational.com

2 DOCUMENT CHECKLIST Please use the checklist below to ensure that all documentation and forms are complete and include the necessary information. A. Business Loan Application Acknowledgement and Agreement (BLAAA) Please include signatures and social security numbers for both you and your spouse, if applicable, on the BLAAA form. Spouse(s) signatures are required by the SBA regardless of whether or not the Spouse is pledging a personal guaranty. B. Personal Financial Statement * (use the attached) Please include signatures and social security numbers for both you and your spouse, if applicable, on the Personal Financial Statement form. Spouse(s) signatures are required by the SBA regardless of whether or not the Spouse is pledging a personal guaranty. C. Three (3) years Business Tax Returns of Borrower (including all schedules) Please include other year-end statement types D. Business plan for a business less than 2 years old or for a business that is planning to implement a turnaround strategy E. Three (3) years of Affiliate business tax returns (including all schedules) This includes tax returns for any business you own 20% or more of (commonly listed in the Schedule E section of your personal tax returns. Affiliates can also be a C Corporation with a separate tax return.) F. Three (3) years Personal Tax Returns (including all schedules) G. Interim Financial Statement (Income Statement and Balance Sheet) Please include year-to-date and prior year to date income statement and balance sheet for borrower and businesses included in (SECTION C) above. H. Business Debt Schedule (see attached) If an existing business, please show al l debt currently on the balance sheet. The total liabilities for short and long term debt should equal what is listed on the balance sheet. Please fill out each field completely. If a new business, there may not be any debt as of yet so please write N/A and sign the schedule. If an acquisition of an existing business, please list any debt that will be inherited as a result of the purchase (per the purchase agreement). If none, please write N/A and sign the schedule. I. Proposed Project Costs For information related to funds to be provided by Borrower, please list where the funds will be coming from including type of funds (e.g. liquidation of stock, home equity loan, business or personal cash) and from who these funds originate (e.g. self, parents, business, etc.) * Required for all owners with a 20% or greater share in the operating company or the real estate holding company.

3 BORROW ER: Borrower and/or Company name: Title: By: OW NERS*/GUARANTORS/SPOUSES (as applicable): (including all owners with 20%+ share)

4 IMPORTANT: Read these directions before completing this Statement. Old National PERSONAL FINANCIAL STATEMENT If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections 1 and 3. If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as a basis for repayment of the credit requested, complete all Sections providing information in Section 2 about the person whose alimony, support, or maintenance payments or income or assets you are relying. We intend to apply for joint credit. Complete all Sections, providing information in Section 2 about the joint applicant and initial here. Joint Applicant If this statement relates to your guaranty of the Indebtedness of other person(s), firm(s) or corporation(s), complete Sections 1 and 3. SECTION 1 - INDIVIDUAL INFORMATION (Type or Print) SECTION 2 - OTHER PARTY INFORMATION (Type or Print) Name Residence Address Position or Occupation Business Name Business Address Res. Phone Bus. Phone Yrs. There Name Residence Address Position or Occupation Business Name Business Address Res. Phone Bus. Phone Applicant Yrs. There SECTION 3 - STATEMENT OF FINANCIAL CONDITION AS OF ASSETS In Dollars LIABILITIES In Dollars (Do not include Assets of doubtful value) (Omit cents) (Omit cents) Cash on hand and in banks Notes payable to banks - secured (see Schedule F) U S Gov't & Marketable Securities - see Schedule A Notes payable to banks - unsecured (see Schedule F) Non-Marketable Securities - see Schedule B Due to brokers Securities held by broker in margin accounts Amounts payable to others - secured Restricted or control stocks Amounts payable to others - unsecured Partial interest in Real Estate Equities - Accounts and bills due see Schedule C Unpaid income tax Real Estate Owned - see Schedule D Other unpaid taxes and interest Loans Receivable Real estate mortgages payable - Automobiles and other personal property see Schedule D Cash value-life insurance - see Schedule E Other debts - itermize Other assets - itemize TOTAL ASSETS SOURCES OF INCOME FOR YEAR ENDED Salary, bonuses & commissions Dividends Real estate income Other 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) TOTAL CONTINGENT LIABILITIES Do you have any contingent liabilities? If so, describe. As endorser, co-maker or guarantor? On leases or contracts? Legal claims Other special debt Amount of contested income tax liens TOTAL LIABILITIES NET WORTH TOTAL LIABILITIES AND NET WORTH PERSONAL INFORMATION Do you have a will? If so, name executor. Are you a partner or officer in any other venture? If so, describe. Are you obligated to pay alimony, child support or separate maintenance payments? If so, describe. Are any assets pledged other than as described on schedules? If so, describe. Income tax settled through (date) Are you a defendant in any suits or legal actions? Personal bank accounts carried at Have you ever been declared bankrupt? If so, describe. Revised 03/05 Personal Financial Statement

5 Number of Shares Or Face Value (Bonds) SCHEDULE A - U.S. GOVERNMENT & MARKETABLE SECURITIES Description In Name Of Are These Pledged? Market Value SCHEDULE B - NON-MARKETABLE SECURITIES Number of Shares Description In Name Of Are These Pledged? Source of Value Value SCHEDULE C - PARTIAL INTERESTS IN REAL ESTATE EQUITIES Address & Type Of Property Title In Name Of % Of Ownership Date Acquired Cost Market Value Mortgage Holder Mortgage Mortgage Balance SCHEDULE D - REAL ESTATE OWNED Address & Type Of Property Title In Name Of Date Acquired Cost Market Value Mortgage Holder Mortgage Mortgage Balance SCHEDULE E - LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE Name Of Insurance Company Owner of Policy Beneficiary Face Amount Policy Loans Cash Surrender Value SCHEDULE F - ALL BANKS OR FINANCE COMPANIES WHERE CREDIT IS OUTSTANDING Name & Address Of Lender Credit In The Name Of Collateral Original Date Amount Current Balance Original Balance The information contained in this statement is provided for the purpose of obtaining, or maintaining credit with you on behalf of the undersigned, or persons, firms, or corporations in whose behalf the undersigned may either severally or jointly with others, execute a guaranty in your favor. Each undersigned understands that you are relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete and that you may consider this statement as continuing to be true and correct until a written notice of change is given to you by the undersigned. You are authorized to make all inquiries you deem necessary and to obtain a consumer credit report from any credit reporting agency to verify the accuracy of the statements made herein, in connection with Bank's preliminary evaluation of undersigned, or during any periodic review of undersigned deemed necessary by Bank. You are authorized to answer questions about your credit experience with me/us. Signature (Individual) S. S. No. Date of Birth Signature (Individual) Date Signed S. S. No. Date of Birth Revised 03/05 Personal Financial Statement

6 BUSINESS DEBT SCHEDULE Business Name Date Signature Creditor * Original Date Original Amount Present Balance Interest Rate Monthly Maturity Collateral/ Security Current Y/N Original Purpose As of: Total *Denotes loan to be refinanced with loan proceeds.

7 PROPOSED PROJECT COSTS Real Estate Acquisition $ Construction/Leasehold Improvements $ Equipment, Furniture & Fixtures $ Inventory Purchase $ Acquisition of Existing Business $ Refinance Existing Debt $ Working Capital $ TOTAL CAPITAL REQUIREMENTS $ Cash to be Provided by Borrower: Cash from Business $ Cash from personal accounts $ Home equity line of credit $ Liquidation of securities $ Personal line of credit or credit cards $ Funds Provided by Other Sources (i.e. Seller Financing) $ TOTAL CASH PROVIDED $ LOAN AMOUNT REQUESTED $ Note: Total cash provided added to loan amount requested, must equal total capital requirements listed above.

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