Business Loan Application

Business Contact Information

First Name*

Middle Initial

Last Name*

Primary Phone*

Email Address*

Best Time to Contact

Method of Contact*

Ownership Information

First Name*

Middle Initial

Last Name*

Social Security #*

Primary Phone*

Secondary Phone

Email Address*

Date of Birth*

Address Line 1*

Address Line 2

Zip*

City*

State*

Loan Request Information

Loan Amount*

Loan Term*

Purpose of Loan*

List of assets to the Purchased or Financed*

Additional Loan Request Information

We must have the following documents before a loan application can be considered.

Copies of the company's financial statement and tax returns for the 3 years.

A copy of the company's most recent interim financial statement for the current year.

A copy of a personal financial statement for each owner listed above.

Equal Credit Opportunity Notice

Were your gross revenues $1,000,000 or less in your previous fiscal year?

If you answered "yes" and the Creditor denies your application for credit, you have the right to a written statement of the reason for the denial. To obtain the statement, please contact:

Within 60 days of the date you are notified of the Creditor's decision. The Creditor will send you a written statement of the reasons for the denial within 30 days of receiving your request for the statement. The notice below describes additional protections extended to you.

Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that applicant has the capacity to enter into a contract); because all of or a part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is: