SMALL BUSINESS LOAN APPLICATION CHECK LIST

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1 SMALL BUSINESS LOAN APPLICATION CHECK LIST This checklist has been provided to assist you through the process of gathering the information for the initial evaluation of your loan request. Complete information will be necessary to process your application. All forms are provided herein unless otherwise noted: 1. Loan Request Form 2. Personal Financial Statement Complete on all owners, directors, guarantors, and stockholders with 20% or more of total stock issued. (Copy form as needed.) 3. Management Resume provide complete resumes on all individuals referred in #2 above. (Copy form as needed.) 4. History of Business Form 5. Estimated Project Costs 6. Certification and permission to obtain personal credit reports. IN ADDITION, PROVIDE THE FOLLOWING: 7. Business Indebtedness Worksheet 8. Three Years Projections of Profit & Loss (Use enclosed form as a guide). 9. Interim Business Financial Statement - must be less than 60 days old. 10. Business Financial Statements and Tax Returns - Income statements, balance sheets, and time periods. tax returns for the three prior year-end 11. Accounts Receivable and Accounts Payable Aging Schedules - as of the same date as the income statement and balance sheet (if applicable). 12. Business Purchase Agreement (if applicable). 13. Historical Financial Information on the Business Being Acquired (if applicable) 14. Uniform Franchise Offering Circular (if applicable). 15. Executed Franchise Agreement or Letter of Approval from Franchisor (if applicable). 16. Construction Quote or Real Estate Purchase Contract for New Building or Expansion (if applicable).

2 APPLICANT COMPANY SMALL BUSINESS LOAN REQUEST FORM Individual Name Company Name Address Title Telephone City State Zip Code Address Type of Entity: Corporation Partnership Proprietorship Not-for-profit LLC Number of Employees: Existing After Loan Date Business Established Business Tax ID Number OWNERSHIP OF APPLICANT COMPANY List below all owners, co-owners, and stockholders of the business. NAME TITLE % of Ownership Are any of the above presently under indictment, on parole, or probation? Yes No Have any of the above ever been charged with or arrested for any criminal offense other than a minor vehicle violation (including offenses which have been dismissed, discharged, or nolle prosequi)? Yes No Have any of the above ever been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation for any criminal offense other than a minor vehicle violation? Yes No AFFILIATES List below all business concerns in which the applicant company or any of the individuals listed in the ownership section above have any ownership. COMPANY NAME OWNER (Applicant Company or Individual) % of OWNERSHIP

3 MANAGEMENT INFORMATION Please fill in all spaces, use full first, middle, and maiden names. If an item is not applicable, please indicate so. PERSONAL Name First Middle Maiden Last SS# Date of Birth Residence Address Place of Birth STREET CITY STATE ZIP Lived at this address since Telephone #: (home) (business) Prior Address STREET CITY STATE ZIP Lived there from MONTH & YEAR To MONTH & YEAR Are you a U.S. Citizen? Yes No If no, give Alien Registration Number EDUCATION DATES DID YOU TYPE OF NAME & LOCATION FROM TO MAJOR GRADUATE DEGREE MILITARY SERVICE BACKGROUND Branch From To Honorable Discharge? Rank at time of Discharge WORK EXPERIENCE (List chronologically, beginning with present employment) Company Name/Location From To Title Duties Company Name/Location From To Title Duties Note: You may include additional information on a separate exhibit

4 HISTORY OF BUSINESS Nature of Business Types of Products/Services Customer Profile List Key Customers List Major Competitors Major Past Accomplishments Future Plans for Growth/Expansion How will this loan benefit your company? Will the funding of this loan create new employment opportunities? If so, state how: (Use separate attachments to answer questions if necessary)

5 ESTIMATED PROJECT COSTS Land acquisition $ New building construction $ Land and building acquisition $ Building improvements or repairs $ Acquisition of machinery/equipment $ Inventory purchase $ Working capital (including accounts payable) $ Acquisition of all or part of an existing business $ Payoff bank loan $ Other debt payment $ Franchise fee $ Closing costs (approximately 5% of the loan amount $ Cost overrun contingency (usually 10% of project cost, as a minimum) $ TOTAL PROJECT AMOUNT $ LESS OWN CASH/EQUITY TO BE INJECTED $< > TOTAL LOAN REQUESTED FOR PROJECT $ NOTE: If you are purchasing a business, please provide a copy of the buy-sell agreement, including a list of assets being purchased and their approximate values. If you are purchasing real estate, please provide a copy of the sales contract. If you are constructing a building, please provide a copy of the plans and contracts/bids for work. Please note: you will probably need to use a registered Class A contractor. If you are refinancing loans, credit lines and/or credit cards, please provide the interest rate, term, monthly payment, collateral, and any other pertinent information. If you are purchasing a franchise, please provide a copy of the franchise agreement and Virginia franchise circular. Comments:

6 PROFIT & LOSS PROJECTIONS Applicant s Name ($000 S) INCOME Gross Receipts Cost of Goods Sold GROSS PROFIT YEAR #1 YEAR #2 YEAR #3 $ % $ % $ % EXPENSES Officer Salaries (if a corporation) Employee Wages Accounting & Legal Fees Advertising Rent Depreciation Supplies Electricity Telephone Interest Repairs Taxes Insurance Bad Debts Miscellaneous Other (explain) TOTAL EXPENSES NET PROFIT BEFORE TAXES LESS: INCOME TAXES NET PROFIT AFTER TAXES LESS: WITHDRAWALS (if proprietorship or partnership) REMAINING NET PROFIT FOR LOAN REPAYMENT Note: please attach assumptions upon which the income and expenses were calculated. I Certify the foregoing data represents the potential annual earnings, to the best of my knowledge. SIGNATURE TITLE DATE

7 BUSINESS INDEBTEDNESS WORKSHEET Please furnish the following information on all installment debts, credit cards, mortgages, lines of credit or other financing. Indicate by an asterisk if the items are to be paid by this financing request. Use additional sheets if necessary. To Whom Payable Original Amount Original Date Current Balance Interest Rate Maturity Date Monthly Payment Security Current or Past Due

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