Commercial Mortgage Application

Transcription

1 Healthcare Financial Services 55 Union Boulevard, 2 nd Floor, Totowa, NJ Toll Free: Quick Response Fax Line: Commercial Mortgage Application For quickest response, please carefully complete all information and FAX to If you prefer, you may drop off your application at a Valley branch or mail it to us at the address above. Please make sure your telephone number is legible to ensure our prompt reply. Name Principals Address State Zip Phone Attorneys' Name Tax I.D. # Phone Fax Application is made to Valley National Bank for a first mortgage of $ at % for years, secured by property at and to be used for the following purpose: To purchase property at in accordance with contract submitted herewith. To construct a building at in accordance with the plans submitted herewith. To refinance existing debts of: Date of Purchase Purchase Price Seller's Name Block Lot Annual Tax Assessment-Land Building Total Size of Lot Type of Building: Stand Alone Medical Facility Medical Office Building Condominium Other Size of Building Number of Stories Number of Units This application and property description are made by the undersigned for the purpose of obtaining a mortgage loan from Valley National Bank and the undersigned hereby represent that to the best of their knowledge and believe the statements contained herein are in all respects true, correct, and complete. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact the person or Healthcare Financial Services Division within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. NOTICE: The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, martial status, age (provided the applicant has the capacity to enter into a binding contract); because all 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 Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is: OCC DEPUTY COMPTROLLER, 1114 AVENUE OF THE AMERICAS, SUITE 3900, NEW YORK, NEW YORK It is understood that all necessary expenses for title examination and the settlement of the loan are to be paid by the borrower. If more than one person signs this application, it is our intent to apply for joint credit. OWNER #1 SIGNATURE DATE OWNER #2 or CO-APPLICANT SIGNATURE DATE 2011 Valley National Bank. Member FDIC. Equal Opportunity Lender. VCS /11

2 Healthcare Financial Services 55 Union Boulevard, 2 nd Floor, Totowa, NJ Toll Free: Quick Response Fax Line: Commercial Mortgage Application TO: Bank Address State Zip Attention Phone Valley National Bank has requested that I provide them with a bank reference in conjunction with a loan request. Please accept this letter as authorization to provide them with pertinent information regarding the status of my individual account(s), business account(s), as well as my credit history, as indicated by the attached information sheet. Signed: PLEASE PRINT: Name Company Name Address State Zip Phone Please return to: Valley National Bank Healthcare Financial Services 55 Union Boulevard., 2 nd Floor Totowa, NJ DEPOSIT ACCOUNTS Account in Account Account Date Number of Current Average Satisfactory name of type number opened ODs balance balance Yes/No LOANS OUTSTANDING Loan in Date of # Times Original Current Installment Secured Satisfactory Loan# name of loan late amount balance Mthly/Qtrly by Maturity Yes/No Are any of the above lines of credit? Credit line available? Outstanding Maturity? Additional information which may be of assistance in determination of credit worthiness BANK OFFICER'S SIGNATURE DATE CUSTOMER SIGNATURE DATE TITLE 2011 Valley National Bank. Member FDIC. Equal Opportunity Lender. VCS /11

3 Healthcare Financial Services 55 Union Boulevard, 2 nd Floor, Totowa, NJ Toll Free: Quick Response Fax Line: Commercial Mortgage Supplement Borrower Address State Zip Property address State Zip Name of owner Phone RENTAL INFORMATION Name of tenant Sq. FT area per unit Rent per unit LEASES Tenant Term Option EXPECTED IMPROVEMENTS Description Cost ANNUAL FIXED CHARGES: OPERATING EXPENSES: Real estate tax $ Electric $ Personal property tax $ Water $ Insurance $ Fuel $ Other $ Rubbish Hauling $ MAINTENANCE EXPENSES: Advertising $ Building improvements $ Miscellaneous $ Personal property $ RESERVE FOR REPLACEMENT: Yard and ground care $ Building components $ Total Annual Expense $ Personal property $ Miscellaneous $ If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact the person or Healthcare Financial Services Division within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. NOTICE: The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, martial status, age (provided the applicant has the capacity to enter into a binding contract); because all 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 Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is: OCC DEPUTY COMPTROLLER, 1114 AVENUE OF THE AMERICAS, SUITE 3900, NEW YORK, NEW YORK SIGNATURE DATE SIGNATURE DATE 2011 Valley National Bank. Member FDIC. Equal Opportunity Lender. VCS /11

4 PERSONAL FINANCIAL STATEMENT AS OF: DATE Personal Information for Applicant Personal Information for Co-Applicant Mr. Mrs. Ms. Mr. Mrs. Ms. Home Address Home Address City State Zip Code City State Zip Code SS # Date of Birth SS # Date of Birth Years at Address Is your home owned? rented? Phone # Cell Phone # Address Business Name or Employer Address City State Zip Code Title or Position Percentage of Ownership Phone # Fax # Website Address Years at Address Is your home owned? rented? Phone # Cell Phone # Address Business Name or Employer Address City State Zip Code Title or Position Percentage of Ownership Phone # Fax # Website Address Annual Sources of Income Annual Expenditures Salary (Applicant) Income Taxes Salary (Co-Applicant) Mortgage Payments Bonuses & Commissions Rental Payments Interest Real Estate Taxes Dividends Loan Payments Real Estate Income Insurance Payments Capital Gains Tuition Other Investment Income Medical Expenses Partnership Income Alimony, Child Support Alimony, Child Support* Other Expenses (List) Other Income (List) Assets Cash in this Bank Cash in Other Banks Marketable Securities Other Securities Accounts Receivable Notes Receivable Residential Real Estate Investment Real Estate Retirement Accounts Personal Property Cash Value Life Insurance Other Assets (List) Income Taxes Payable Notes Payable this Bank Other Notes Payable Residential Mortgages Home Equity Mortgages Investment Mortgages Credit Cards Other Taxes Payable Margin Accounts Life Insurance Loans Other Liabilities (List) Liabilities Total Income Total Expenses Total Assets Total Liabilities *Income from Alimony, child support or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying this loan. Schedule of Readily Marketable U.S. Government Securities, Stocks and Bonds Owned (Attach Schedule, as needed) No. of Shares Description Owners Where Held Current Value Pledged? Other Non-Readily Marketable Securities Owned No. of Shares Description Owners Where Held Current Value Pledged? Description and Address Owners Schedule of Real Estate Owned Year Purchased Amount Paid Market Value Mortgage Balance Lender Maturity Date

5 Schedule of Life Insurance Insurance Company Face Amount Owner Beneficiary Cash Value Amount Borrowed Schedule of Notes or Lines of Credit Payable Lender Type of Note Amount Secured Unsecured Collateral Balance Due Schedule of Business Ownership and Partnership or LLC Investments Name of Business or Investment Type of Business or Investment Year Acquired Original Cost Percent Owned Current Value Balance Due on Investment Please Answer the Following Questions: 1. Number of Dependents (excluding yourself): 2. Are you a Citizen of the United States of America? 3. Federal 1040 Tax Returns are filed through (date): Are any returns currently being audited or contested? Name and telephone number of your accountant: 4. Have (either of) you or any firm in which you were a major owner ever declared bankruptcy? Yes No 5. Do (either of) you have a Line of Credit or unused credit facility at any other institution? If yes, please indicate where and for how much: Contingent Liabilities 1. Are (either of) you a guarantor, co-maker, or endorser for any debt of an individual or business entity? Yes No Amount 2. Are you contingently liable on any lease or contract? 3. Are there any legal actions pending against (either of ) you? 4. Are any of your tax liabilities past due? If Yes to any of the above, please provide details: Representations and Warranties The information contained in this statement is provided to induce Valley National Bank ("you") to extend or to continue the extension of credit to the undersigned or to others upon he guarantee of the undersigned. The undersigned acknowledge and understand that you are relying on the information provided herein in deciding to grant or continue credit or to accept the guarantee thereof. Each of the undersigned represents, warrants and certifies that the information provided herein is true, correct and complete. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change (1) in any of the information contained in this statement or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform its (or their) obliga ions to you. In the absence of such no ice or a new and full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail to notify you as required above, or if any of the informa ion herein should prove to be inaccurate or incomplete in any material respect, you may declare the indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein and to determine the credit-worthiness of the undersigned. You may request a consumer report in connection with this application and subsequent consumer reports in connection with updating, renewing, or extending the existing or future extensions of credit. Upon the undersigneds written request, you will provide the name and address of the consumer reporting agency furnishing reports to you, if any. As long as any obliga ion or guarantee of the undersigned to you is outstanding, the undersigned shall supply annually an updated financial statement. This personal financial statement and any other financial or o her information that the undersigned give you shall be your property. Signature of Applicant Date Signature of Co-Applicant Date 2011 Valley National Bank. Member FDIC. IMPORTANT INFORMATION FOR THE ABOVE SIGNER(S) ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT - To help government fight the funding of terrorism and money laundering activities, applicable law requires Valley National Bank ("Valley") to obtain, verify, and record information that identifies each person who opens an account. What this means for the above signer(s): When you open an account, Valley will ask for your name, address, date of birth, and other information that will allow Valley to identify you. Valley may also ask to see your driver's license or other identifying documents. VNB-F18000 (Rev. 10/11) VCS-4359

6 Healthcare Financial Services 55 Union Boulevard, 2 nd Floor, Totowa, NJ Toll Free: Quick Response Fax Line: Borrower's Environmental Questionaire (EXHIBIT CPM6) FACILITY INFORMATION Facility Address: Telephone: Lot and Block Number: Facility Owner: Telephone: Describe Current Use of the Facility: SIC Codes Of All Current Uses: Year Current Operations Began: Date Current Owner Took Title: Total Acreage: Number of Buildings On Property Age of Buildings: Number of Employees On Site: Prior Facility Owner: Telephone: Prior Owner s Current Address, if known: Describe Prior Use of the Facility: (Answer each question with a Yes or No. When an explanation is needed, write in a number as part of the question s answer, and then attach a written numbered comment.) HISTORY OF THE PROPERTY 1. Has the Property ever been used for agriculture, an industrial manufacturing operation, a gas station, motor repair facility, automotive repair facility, commercial printing facility, dry cleaners, photo developing laboratory, junk yard, landfill, dump site, oil refinery, or a waste storage, treatment, disposal, processing or recycling facility, or any other purpose where hazardous substances may have been used or stored? 2. Has the Property ever been the subject of an ECRA or ISRA case? 3. If yes to question number 2, was a No Further Action Letter issued? Date of NFA Letter: 4. If yes to question number 2, was a Negative Declaration issued? Date of Negative Declaration: 5. Has there been any known spill case or contamination found on the Property? 6. Has there ever been a fire on the property? 7. Has fill dirt been brought onto the Property? 8. Are there any easements on the property for underground pipelines or high-tension wires? 9. Have there ever been any pits on the property? Ponds/Lagoons for hazardous waste disposal? Unidentified waste materials? CURRENT OPERATIONS 10. Do you employ an in-house environmental manager? 11. Do you keep Material Safety Data Sheets available? 12. Please attach a list of any environmental permits you have (e.g. water discharge, air discharge, generation/transport/storage of hazardous waste, etc.). 13. Have you recently been inspected by the State? OSHA? EPA? Local Health Department? 14. If yes to question 13, were you cited for any violations? 15. Please attach a description of how hazardous substances are stored. Page 1 of 3

7 HAZARDOUS MATERIALS, STORAGE, AND DISPOSAL 16. Are drums of chemicals, pesticides, solvents, cleaning fluids, or other potentially hazardous materials stored on the site? 17. If so, is there any evidence of spills, leaks, or discharges into the ground from the drums? 18. Are there any areas at the site where the ground is stained or where there is dead or stressed vegetation? 19. Does the facility generate hazardous waste as part of its operations? 20. If yes, does the facility have an EPA ID number? If so, what is the number? 21. How are hazardous waste/byproducts disposed of (please attach the name of the hauler if one is used)? 22. Does there appear to be any radioactive material on-site? 23. Has the facility ever received a notice of violation or other similar claim from a regulatory agency for improper hazardous materials storage or disposal on the site? 24. If the facility has received such a notice, have all issues related to the notice been satisfactorily corrected? 25. Has the facility ever received a notification letter from the EPA or a state agency about involvement, or potential involvement, in a Superfund site cleanup on this site or at an off-site location? 26. Is the facility free of any current or pending legal action of any kind related to hazardous materials, waste, storage, or disposal? ASBESTOS 27. Were the facilities on the property constructed prior to 1979 (the year asbestos use as insulation was banned)? 28. Has an asbestos survey of the facility been conducted? 29. If yes, did the survey find the buildings to be free of asbestos-containing materials? 30. Does a walk-through of the property reveal any evidence of insulation, fireproofing, or building materials that may contain asbestos including on or around boilers, pipes, ducts, ceilings, walls, stucco, plaster and roofing materials? 31. If yes, does the suspicious material appear to be crumbling, flaking, damaged, or broken? RADON 32. Have radon tests ever been performed at the property? 33. If yes, were they EPA-approved tests? 34. If no to 32, is there any evidence that this property or surrounding properties might have elevated radon levels? 35. If yes to 32, were the results below the 4 picocuries per liter limit established by the EPA? 36. If no to 35, have ventilation systems (or other remedial measures) been installed? Explain how fixed: INDOOR POLLUTION 37. Does the facility appear to be free of sources of air emissions that have chemical odors, fumes, or mists? 38. Is there any lead based paint on the premises? 39. Have there been any complaints or claims filed by any workers at the property for any environmental health reasons? 40. Where does the water supply come from? Has the drinking water at the property been tested? If yes, is it within acceptable EPA standards? 41. Have there been previous problems with below-standard drinking water at the facility? 42. Have there been any problems with below-standard drinking water at locations adjacent to the facility? UNDERGROUND STORAGE TANKS 43. Does the property contain underground storage tanks? 44. Please attach a list of the materials that are stored in these tanks. 45. Have the tanks been tested for tightness? Are any tanks known to be leaking? 46. Have there been any incidences of leaks, spills, or discharges in the past? 47. Have the proper registration forms been submitted to the appropriate state regulatory agencies for any tanks that exist on the property? 48. Are leak detection equipment or secondary containment systems installed on any tanks that exist on the property? 49. Is there a program in place to upgrade any tanks that exist on the property to meet EPA standards? Page 2 of 3

8 POLYCHLORINATED BIPHENYL'S (PCBS) 50. Does the facility contain any equipment, such as transformers or capacitors, which may contain PCBs? 51. If PCB-containing electrical equipment is present at the property, is it marked with yellow PCB labels? 52. If PCB-containing electrical equipment is present at the property, is there evidence of leaks or spills on the ground adjacent to the equipment? ENVIRONMENTAL HAZARDS ON ADJACENT PROPERTIES 53. Do adjacent properties appear to be free of any improper storage or dumping of hazardous waste, drums, or other containers that could affect this property? 54. Are there any landfills, dumps, or other waste disposal facilities located on adjacent properties? 55. Are any of the following located on adjacent properties: gas stations, chemical plants, bulk storage tanks, or manufacturing plants? CHECKLIST CERTIFICATION This is to certify that the undersigned, on the date indicated below, did an environmental inspection of the above-named facility and that the results of the inspection are as indicated on this checklist (and the numbered notes that accompany it) to the best of my knowledge and belief. DATE AUTHORIZED SIGNATURE (Print name and title) FIRM Page 3 of Valley National Bank. Member FDIC. Equal Opportunity Lender. VCS /11