Small Business Administration Loan Application

Transcription

1 BUSINESS INFORMATION Small Business Administration Loan Application Business Name Structure (Corporation, Partnership, Sole P., LLC) Address Type of Business City, State, Zip No. of Employees: Before After Business Telephone Current Bank Business Fax Bank Address Address: City, State, Zip Tax ID Number Web Address Date Established Contact Person ESTIMATED PROJECT COSTS Land Acquisition Land and Building Acquisition Machinery and Equipment Furniture and Fixtures Inventory Purchase Working Capital Refinance Existing Bank Debt Refinance Other Debt Acquisition of Existing Business Loan Closing Costs Other Other Total Capital Requirements _ Cash Provided by Borrower Funds Provided by Other Sources $( ) $( ) Loan Amount Requested _

2 BUSINESS OWNERSHIP Small Business Administration Loan Application List the owners of your company, partners, directors, members, and all holders of outstanding stock. 100% ownership must be shown: Name Title % Ownership OWNERSHIP INTERESTS IN OTHER ENTITIES & AFFILIATES List any other business concerns in which the applicant company or any of the individuals listed above have ownership. Name Title % Ownership SBA OR OTHER FEDERAL GOVERNMENT DEBT HISTORY Name of Agency Original Loan Amount Date of Loan Balance Status (Current or Past due) ADDITIONAL INFORMATION: 1. Have you or any officer of your company ever been involved in bankruptcy or insolvency proceedings? 2. Are you or your business involved in any pending/unsettled lawsuits? If so, please explain on a separate sheet of paper and attach to application.

3 3. Is this business a franchise? If yes, franchise name: 4. Does any applicant or their spouse or any member of their household, or anyone who owns, manages, or directs your business or their spouses or members of their households, work for the Small Business Administration, Small Business Advisory Council, SCORE, or ACE, any Federal Agency, or the participating lender? 5. Have you received counseling or training from SBA? 6. Do you buy from, sell to, or use the services of any concern in which someone in your company has a significant financial interest? 7. Does your business presently, or will it as a result of this loan, engage in export trade? If yes, what are your total export sales being supported with this loan request? 8. Would you like additional information on exporting? 9. Did you pay anyone to assist you with the preparation of this form? If so, please provide the person s name, occupation and fee paid.

4 BUSINESS PROFILE Please answer the questions below or provide the information on a separate attachment. 1. Describe the history of your business. (Include year founded, services/products provided, location, target customers, suppliers and competitors). 2. How will this loan change or aid the growth of your business? By signing below, you certify the information you ve provided is true and complete. You authorize FirstMerit Bank to verify your statements with any source and obtain credit and employment history. Date Signature Title Name (printed) MANAGEMENT PROFILE A management profile must be completed by the proprietor, each partner, each holder of 20% or more of common stock and/or key management. You may attach your education and employment history separately if preferred. Name SS# Date of Birth Place of Birth Home Phone Business Phone Are you a U.S. Citizen? Yes No (If No, provide Alien Registration Number and copy of Green Card)

5 Education Institution Dates Attended Degree(s) Institution Dates Attended Degree(s) Employment History for last 10 years Position/Title From To Position/Title From To Position/Title From To Information for Government Monitoring Purposes The following information is requested by the Federal Government for certain types of loans in order to monitor the Lender s compliance with equal credit opportunity laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may neither discriminate on the basis of this information, nor on where you choose to furnish it. However, if you choose to furnish it, under the Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the information below, please check the following box. Applicant: I do not wish to furnish information. Race (one or more boxes may be selected) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White Ethnicity Hispanic or Latino Non-Hispanic or Non-Latino Gender Male Female Veteran Status US Veteran: No Yes (If yes, was Service Disabled ) Signature Date