Use this form to electronically submit your loan request to us. Alternatively you may click on the link below to download a copy of the loan request in PDF format. PDF format requires the use of the Adobe Acrobat Reader, if you do not have a copy of the Acrobat Reader installed on your computer click on the get Acrobat Reader button to obtain your copy.

Instructions if submitting electronically: Submit this Form Page 1st, then submit any continuation forms, if needed.

Applicant Company

Company Name
Telephone
Address
City
State
Zip
Date Established
Name of Franchise (If Applicable)
----------------------------------- ------------------------------------------
FAX #
E-mail Address

Select Type of Entity:

Corporation (S or C)
Sole Proprietorship (D/B/A)
General Partnership
Limited Partnership
LLC 

If LLC - Need  # of members

Ownership of Applicant Company
List below all owners, partners, and stockholders with 20% or more ownership interest

Name Name
Title Title
Address Address
City, State Zip City, State Zip
Telephone Telephone
% of Ownership % of Ownership
Social 
Security #		 Social Security #
- -
Name Name
Title Title
Address Address
City, State Zip City, State Zip
Telephone Telephone
% of Ownership % of Ownership
Social 
Security #		 Social 
Security #
If additional owners, please attach on a separate sheet or
 if submitting electronically go to the Ownership Continuation Form

Affiliates
List all business concerns in which the applicant company or any individuals listed in the Ownership section above have any ownership.

Name Name
Individual Name Individual Name
Address Address
City, State Zip City, State Zip
Telephone Telephone
% of Ownership % of Ownership
Social
Security #		 Social
Security #
If additional affiliates, please attach on a separate sheet or
 if submitting electronically go to the Affiliates Continuation Form
 

 

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