Loan Application

Welcome to our Online Loan Application Form. This is the first step in helping you realize your dream. This form was designed to be user-friendly and will take you approximately 20 minutes to complete. For security reasons, you cannot save this form in process or return to it later. Please be sure to have your most recent year’s business financials (if applicable) and your personal financial information. You will receive an email confirmation after you submit your online application. Do not be concerned if you realize you made an error after submitting this application. A lender will be contacting you within the next business day to discuss your application in more detail. Thank you.

Loan Request

Loan Amount Requested

Loan Purpose

0 / 200

Is your business already started?

YesNo

Business Start Date(or will be started)

Loan Application

About You

First Name

M.I.

Last Name

Emaila valid email

Phone NumberBest contact phone number

Home Address

City

ST

Zip Code

Birthdate

Social Security Number

Are You Self-Employed

YesNo

Your Current Monthly Income

Name of Current Employer

Position at Current Employer

Percent of Business Ownership

100% • I am the only ownerThere are other owners

% of Business You Own

NOTE: Each owner of this business must complete the required information below.

Loan Applicant #2

First Name

M.I.

Last Name

Emaila valid email

Phone NumberBest contact phone number

Home Address

City

ST

Zip Code

Social Security Number

Birthdate

Are You Self-Employed

YesNo

Your Current Monthly Income

Name of Current Employer

Position at Current Employer

% of Business Owned by Applicant #2

Is there a third owner of this business?

YesNo other owners

Loan Applicant #3

First Name

M.I.

Last Name

Emaila valid email

Phone NumberBest contact phone number

Home Address

City

ST

Zip Code

Birthdate

Social Security Number

Are You Self-Employed

YesNo

Your Current Monthly Income

Name of Current Employer

Position at Current Employer

% of Business Owned by Applicant #3

Is there a fourth owner of this business?

YesNo other owners

Loan Applicant #4

First Name

M.I.

Last Name

Emaila valid email

Phone NumberBest contact phone number

Home Address

City

ST

Zip Code

Birthdate

Social Security Number

Are You Self-Employed

YesNo

Your Current Monthly Income

Name of Current Employer

Position at Current Employer

% of Business Owned by Applicant #4

Loan Application

About Your Business

Name of the Business

Type of Business

0 /

Business Phone Number

Business Website

Business Physical Address

City

ST

Zip Code

Business Mailing Address?

Same as aboveDifferent

Business Mailing Address

City

ST

Zip Code

EIN (Tax ID#)

Business Net Income This Year

Business Net Income Last Year

Loan Application

Submit Application

Additional Information (optional)

Please include below any other information you would like to submit with this loan application for our consideration.

Additional Information (optional)

0 / 2000

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 the applicant has the capacity to enter into a binding contract); because all of part or 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 Protection Act.

Signature:

Authorization

Every applicant has read the authorization above and agree to the terms put forth by the lender.

Every applicant understands there will be additional information and paperwork required to obtain final approval for a loan from the lender.

As the primary applicant for this loan, I have authorization from any/all other co-applicants to provide this information to the lender.

Please specify the best time for us to contact you.

Thefollowing information is requested by the federal government to comply withcertain equal credit opportunity, fair housing, and home mortgage disclosurelaws. You are not required to provide this information but are encouraged to doso. The law provides that the lender may not discriminate on the basis of thisinformation, or on whether you chose to furnish it.