Full Application

Business Loan Application Form

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SECTION 1: BUSINESS INFORMATION

Business Name:

DBA (if applicable):

Business Address:

City:

State:

ZIP:

Phone Number:

Email Address:

Website (if any):

Tax ID (EIN):

Business Type (LLC, Corp, etc.):

Date Established:

Industry:

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SECTION 2: OWNERSHIP INFORMATION

Owner's Full Name:

Title/Role:

Ownership Percentage:

Home Address:

City:

State:

ZIP:

Phone Number:

Email:

SSN:

Date of Birth:

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*Repeat for any additional owners with 20% or more ownership.*

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SECTION 3: LOAN REQUEST

Loan Amount Requested:

Loan Purpose:

Preferred Repayment Term:

Collateral (if any):

Preferred Repayment Term:

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SECTION 4: BUSINESS FINANCIALS

Annual Revenue:

Monthly Revenue:

Average Bank Balance:

# of Business Bank Accounts:

Do you have any existing business loans?

If yes, list lender(s) and amounts:

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SECTION 5: AUTHORIZATION AND SIGNATURE

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I certify that the above information is true and correct to the best of my knowledge. I authorize the lender and its agents to verify all information provided, including credit and background checks.

Signature:

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Name:

Date:

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