LOAN CO-APPLICANT FORM

LOAN CO-APPLICANT FORM Thank you for your interest business financing from the NC Rural Center, a non-profit organization focused on self-employment, business creation and economic independence for the residents of North Carolina. ELIGIBILITY You own and operate a legal business in rural N.C. or plan to do so. Are at least 18 years of age. Your credit shows a successful repayment history. We use a credit score of 575 or above as a guideline, but there is not a required minimum. You do not have any active judgments, foreclosures, or federal obligations in default. DIRECTIONS FOR COMPLETING APPLICATION All applicants must submit a Pre-Application before submitting an Application. Once the Pre-Application is approved, an Application must be completed in its entirety before we can proceed. Your initials are required on each page of the Application in the lower right-hand corner. All co-signers/guarantors must initial and sign the Application and complete a separate Co-Applicant Form. Please be sure that you take the time to submit the most current and accurate information. Please feel free to include any additional information that you believe will help make an informed decision regarding your request (e.g., photos, documents, news stories, explanations of past credit issues). Required Documents For All Co-Applicants: Completed Application (by applicant and co-applicants) Completed Co-Applicant form (by all co-applicants) Income documentation (two most recent pay stubs from all jobs) Three most recent personal bank statements Resume Documentation of proposed collateral (copy of car title, deeds, etc.) For Loans above $5,000 Required Documents Also Include: Copy of most recent personal tax return For Loans above $15,000 Required Documents Also Include: Copy of previous year s personal tax return (totaling two personal tax returns) Check Submit by email, fax, or mail to: JaLisha Richmond Email: jrichmond@ncruralcenter.org Fax: 919.250.4325 N.C. Rural Economic Development Center 4021 Carya Drive Raleigh, NC 27610 Questions? Call JaLisha Richmond, Program Associate at 919.250.4314 Page 1 of 5

PERSONAL INFORMATION Name of Co-Applicant (First, Middle, Last): _ Street Address: City: State: Zip: County: Social Security or Individual Taxpayer Identification Number: _ Date of Birth (MM/DD/YYYY): Primary Phone: Secondary Phone: N.C. Driver s License Number: _ Email Address: EMPLOYMENT INFORMATION Are you currently employed? Yes No Provide your last employer s name, address and telephone number below: Employer: _ Street Address: City: State: Zip: County: Phone Number: May we contact this employer to verify loan information? Yes No Dates of employment: Start Date End Date How many hours do you work per week? _ What is your job title? Do you plan to keep this job while operating your business? Yes No Where will you obtain the money to repay this debt if the business is not profitable? ALTERNATE CONTACT INFORMATION Please provide names of two relatives or close friends not living with you as alternate contacts in the event we re unable to reach you. Alternate Contact 1 Alternate Contact 2 Name: Relationship: Address: _ City, State, ZIP: Telephone: Email: Name: _ Relationship: Address: City, State, Zip: _ Telephone: Email: _ Page 2 of 5

PERSONAL ASSET STATEMENT Please provide us with information about your personal assets. Assets are those resources you own that have economic value (e.g. your home, car, land). If more space is needed, please attach additional sheets. Do you own your home? Yes No If yes, is it a House Mobile Home Condominium Other Name of mortgage holder: If you rent, please provide your landlord s name, address and phone number: Assets Value Liabilities Value Cash on hand $ Credit Card balances $ Savings Accounts $ Bank/Credit Union loan balances $ Automobiles (Present Value) $ Automobile loan balances $ Value of your home $ Mortgage balance on your home $ Value of other real estate you own $ Mortgages on other real estate $ IRA/Retirement Account $ Taxes $ Stocks and Bonds $ ( ) $ Other Assets ( ) $ ( ) $ Other Assets ( ) $ ( ) $ Total Assets $ Total Liabilities $ Net Worth (Total Assets Total Liabilities) $ PERSONAL MONTHLY BUDGET Income Please provide us with detail about your monthly income (you only) and your household s monthly income (you plus other household earners). Your total income should include all salary and wage payments, owner s draw from your business, and any other revenue sources you have (e.g. rental income or government assistance). Source: Applicant s Monthly Income (You) Jobs/Employment $ $ Business $ $ Government Income/Assistance $ $ Other ( ) $ $ Other ( ) $ $ Total $ $ Household s Monthly Income (You+Spouse+Others) Page 3 of 5

Expenses Please provide the following information for any loan or debt payments you have. Include: Loan Type (description) Monthly Loan Payments Original Lender Name Balance Current Balance Monthly Payments Ex: Loan, Credit Card, Auto, Mortgage ABC Bank $100,000 $50,000 $1,000 Total Monthly Expenses Expense Monthly Payments Total Loan Payments (from above) $ Auto Insurance, Repairs, and Fuel $ Household Insurance and Property Taxes $ Utilities $ Food and Clothing $ Medical Expenses $ Child Care $ Alimony $ Child Support $ Other () $ Other () $ Total $ Page 4 of 5

COLLATERAL INFORMATION Please provide us with information about the assets available to secure this loan. Assets available to secure this loan (describe) Value of Asset Loans on Asset Title or Deed Attached? Vehicle 1 (_) $ $ Vehicle 2 (_) $ $ Property 1 () $ $ Property 2 () $ $ Inventory (_) $ $ Equipment () $ $ Other ( ) $ $ Total $ $ SIGNATURE The undersigned hereby authorizes the Rural Economic Development Center or any of its affiliates to make all inquiries with credit bureaus and others it deems necessary including business counselors, consultants and partnering agencies to verify the accuracy of the information provided herein and to determine credit worthiness. Further, the undersigned hereby certifies that the enclosed application information is valid, accurate and complete. The undersigned hereby further certifies that the proceeds of any loan made as a result of this application will be used for business purposes only and will not be used to cover current debt, general fees related to the preparation of this document or personal or consumer purchases. Co-Applicant Name: Signature: Date: Page 5 of 5