SBA Application ABOUT YOUR BUSINESS:

Transcription

1 MBB If the basis (Ownership minimum 51%) BB If Program participated in Copy of completion/certificate attached SBA Completion 1st Only Source SBA Application 1st Source Bank Date of Application ABOUT YOUR BUSINESS: 1. Business Legal Name: 2. Business Address: 3. Business Phone Number: Business Duns# (If known): 4. Brief Summary of Business: 5. Description of Business: 6. Length of time in Business: 7. Length of time under current management: 8. How many employees does your business have? Before the Loan After the Loan 9. Has the applicant or any owner of 20% or more of the company ever defaulted or is currently in arrears on a government debt or student loan? Yes No 10. Is the business a franchise or will it operate under a licensing, jobber or dealer agreement? If yes, please provide a copy of the applicable agreement and franchise offering circular. Yes No 11. Is the business or its activities connected, associated or affiliated with a religious Organization in any way? Yes No 12. How did you learn about the SBA program at 1st Source? Advertising Word of Mouth Current Customer Directly from SBA Other: 13. Ownership information: Please complete all columns for all owners of the company and joint-applicants. Ownership must total 100%. * include information for all day-to-day managers, regardless of ownership. Owners/Applicants: Day-to-Day Managers *If not a US citizen, provide USCIS (INS) documentation of Residency status 14. To determine eligibility for Patriot Express, please answer the following questions: Are 51% or more of the ownership group: Veteran Yes No Service Disabled Veteran Yes No Active Duty Military service member in Transition Assistance Program (TAP) Yes No Reservists and National Guard Members Yes No Widowed Spouse of a Service Member who died while in Service Yes No Widowed Spouse of a Veteran who died of a service connected disability Yes No

2 *Provide DD214 for Veterans or other required documentation 15. Are you presently subject to an indictment, criminal information, arraignment or other means by which formal criminal charges are brought in any jurisdiction? Yes No 16. Have you been arrested in the past six months for any criminal offense? Yes No 17. For any criminal offense other than a minor vehicle violation have you ever: 1) been convicted; 2) plead guilty; 3) plead nolo contendere; 4) been placed on pretrial diversion; 5) been placed on any form of parole or probation (including probation before judgment? Yes No 18. Is any principal of the business delinquent on any obligation to pay child support? Yes No 19. Is any principal debarred, suspended or declared ineligible for participating in this transaction by a Federal Department or Agency? Yes No 20. Have you or do you intend to pay a broker for this loan? Yes No 21. Please provide the following information for each 20% or more owner and for each key employee: Work Experience list chronologically, beginning with present employment. Attach separate exhibit (resume) if necessary. 1) Company Name/Location: From: To: Title: Duties: 2) Company Name/Location: From: To: Title: Duties: Education: College or Technical Training Date Attended Major Degree/ Name and Location From/To Certificate Residence Information: Date of Birth: Current Home Address: Place of Birth: Number of Years at address: (if less than 10 yrs, provide previous address) Please include additional information concerning Management capabilities/preparation for this role: 22. Please provide the following information on the company s current debts (including any debt to be refinanced). Indicate debts to be refinanced with an asterisk* Creditor Purpose Original Date Original Amount Present Balance Int Rate Monthly Payment Maturity Date Collateral The following will be required for all debt being refinanced: Copy of note(s), debt instruments and/or statement or receipts (credit cards) to be refinanced. 23. Are any loans to be refinanced SBA guaranteed? Yes No

3 24. Please provide tax returns for the past three years of operation. Signed and dated 25. Please provide interim business financials not more than 60 days old. Signed and dated 26. Please provide joint personal financial statements for all principals with 20% or more ownership, dated within the past 60 days, signed by spouse, if applicable. ABOUT YOUR PROJECT: 1. Please complete the following Use of Proceeds listing by dollar amount: Real Estate Payoff SBA Loan Construction Machinery/Equipment Inventory Working Capital Acquisition of Business Fees and Soft Costs Payoff Bank Loan Other Debt Payment TOTAL PROJECT Equity Injection* Loan Amount Seller/Other Financing *Please identify equity injection: Source of Equity Injection $ Amount 2. Will the loan request be for real estate financing? Yes No If yes, please provide copy of the real estate purchase agreement 3. What percentage of the property will be owner occupied: If less than 100%, when does the company expect to fully occupy the building? 4. Will loan proceeds be for new construction, real improvements or tenant improvement? Yes No If yes, please provide a copy of the cost breakdown 5. Will the assets purchased with loan proceeds be owned by (or titles to) a separate entity? Yes No If the borrower is different than the operating business (as with a holding company formed specifically to own real property) please complete the ELIGIBLE PASSIVE COMPANY section on page If the project proposed for financing has soft costs that will be paid by the borrower (such as appraisal and title fees), please estimate these costs $ Has this amount been recognized in the Source of Equity table above? Yes No 7. Will loan proceeds be for the purchase of an existing business? If yes, please provide the following: A copy of the purchase/sale agreement with breakdown of purchase price Copy of Seller s tax returns and year-end financials for the last three years Copy of Seller s interim business financial statement (not more than 60 days old) Explanation as to why business is being sold Yes No AFFILIATES If yes to any of the following questions, please complete the Affiliate table below: 1. Does the applicant or any of its principals own 50% or more of another business or other businesses? Yes No 2. Is the applicant involved in a joint venture with another business or other businesses? Yes No 3. Does another business own 50% or more of the applicant? Yes No

4 4. Does a third party have the ability to control the applicant? Yes No 5. Are any of the principals of the applicant required to submit a Schedule C, Schedule C-EZ and/or Schedule E of their personal 1040 federal tax return? Yes No Name of Affiliate Business NAICS Code Last 3 Years Average Revenue # of Employees *If NAICS code is unknown, please state nature of business PRIOR GOVERNMENT FINANCING 1. Does the applicant or affiliates have any SBA debt outstanding? If yes, please name the financial institution Current loan balance $ 2. Have the applicant or affiliates previously obtained any SBA or other government financing? If yes, complete the following: Yes Yes No No Name of Agency Original Loan Amount Date of Request Approve / Decline $ $ Balance Current or Past Due $ $ ELIGIBLE PASSIVE COMPANY (EPC) Fill out this section only if you have answered Yes to question 5 under the section ABOUT YOUR PROJECT. An EPC condition exists when an entity different then the operating company will own the property. If an EPC, complete the following ownership grid on the owners of the EPC and the Operating Company (OC): Please note the Operating Company must be a guarantor or co-borrower. EQUAL CREDIT OPPORTUNITY STATEMENT 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, or age (provided the applicant has the capacity to enter into a binding contract); or 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 oversees 1st Source Bank s compliance with this law is: Federal Reserve Bank Consumer Help, P.O. Box 1200, Minneapolis, MN 55480, Phone: (888) PERSONAL INFORMATION AUTHORIZATION If Applicant is an individual, then the undersigned hereby authorizes 1st Source Bank to obtain a consumer credit report and otherwise verify, in any manner it deems appropriate, the undersigned s employment history and income, bank accounts, payment histories, and income tax returns. This authorization remains in effect now and during the life of the undersigned s relationship with 1st Source Bank. A copy of this authorization may serve as equivalent to the original and used as a duplicate original.

5 INFORMATION REQUIRED 1st Source Bank will require information from Applicant that 1st Source Bank regularly obtains and considers in evaluating credit applications for the purpose and amount of the credit requested. The Bank may require a Personal Financial Statement. NOTICE OF CREDIT DECISION 1st Source Bank will notify Applicant of its credit decision within 30 days of a completed credit application. If the application is declined, 1st Source Bank will then provide written notification to Applicant. Please complete all columns for all proposed Applicants and Guarantors: Applicant / Guarantors Address Tax ID Number Business Start Date Phone Military Y/N Date of Birth Check applicable boxes: Applicant is applying for individual credit and requests that the loan decision be based on individual income and assets and not income and assets of another person or entity as the basis of repayment of the credit decision Applicants are applying for joint credit and request that the loan decision be based on joint and individual income and assets. Applicants intend to apply for joint credit (initials) : Applicant Co-Applicant Applicant(s) is/are guaranteeing the indebtedness of another person, firm or corporation. X X Applicant #1 Date Applicant #2 Date Printed Name Applicant #1 Printed Name Applicant #2 X X Applicant #3 Date Applicant #4 Date Printed Name Applicant #3 Printed Name Applicant #4 FOR LENDER USE: SBA Loan Type: 7a Express SLA(Small Loan Advantage) Loan Type: Revolving Term Term of Loan requested: (months) Repayment Terms: Monthly Other FOR OFFICE USE ONLY: Check and submit to Credit Department: Date of completed application: (Insert Date Required) Application Withdrawn Credit request approved: (Insert Date Required) Application Incomplete Credit request declined on: (Insert Date Required)* *Also required: Attach Statement of Business Denial, Termination or Change and submit to Credit Department with Application File.