Applications
APPLICATION FOR BUSINESS LOAN
APPLICANT COMPANY
Company Name ______________________________________ Telephone: (_____)____________________________
Fax: ( )_________________________ Email: _____________________________________________
Address: ______________________________________________________________________________________________
City: _____________________________________ County: _______________________ State: _______ Zip: ____________
Type of Business: _______________________________________________ Date Established: ______________________
Type of entity: Corporation Partnership Sole Proprietorship
Other
Number of Employees: Existing: ________ If Loan is Approved: ________ Affiliates: ________
Have you or any officer of your company ever been:
Involved in bankruptcy or insolvency proceedings?
Yes No (If yes, furnish details in a separate exhibit.)
Currently Exporting?
Yes No
Planning to Export?
Yes No
Exporting Information Needed?
Yes No
Bank Contract: _______________________________________ Telephone: (______)______________________
Accountant Name: ____________________________________ Telephone: (______)______________________
Attorney Name: ______________________________________ Telephone: (______)______________________
Ownership of Applicant Company
– List below all officers, directors, partners, owners and co-owners, and all stockholders of record. All (100%) stock ownership must be shown. Include a resume for each person listed below and a personal financial statement if ownership is over 20%.
NAME TITLE % OF OWNERSHIP ANNUAL COMPENSATION AFFILIATES
– List below all business concerns in which the applicant company or any of the individuals listed in the ownership section above have any ownership.
COMPANY NAME OWNER
(APPLICANT COMPANY OR INDIVIDUALS)
% OF OWNERSHIP
PREVIOUS GOVERNMENT FINANCING
– If you or any principals or affiliates have ever requested government
financing (including SBA loans and government guaranteed student loans), complete the following.
NAME OF AGENCY AMOUNT DATE
SUMMARY OF PROJECT COST COLLATERAL VALUE
Land and Improvements $ _________________________ Land and Improvements $ _________________________
Building Construction $ ____________________ _____ Machinery & Equipment $ _________________________
Machinery & Equipment $ ____________________ _____ Furniture & Fixtures $ _________________________
Inventory $ ____________________ _____ Accounts Receivable $ ____________________ _____
Working Capital $ ____________________ _____ Inventory $ ____________________ _____
Other _______________ $ ____________________ _____ Other _______________ $ ____________________ _____
Refinance Existing Debt* $ ____________________ _____
Total Collateral Value
$ ____________________ _____
Total Project Cost
APPROVED OR DECLINED
BALANCE STATUS
$ ____________________ _____
Less Owners Equity $ ____________________ _____ Less Seller Debt $ ____________________ _____
Total Loan Requested
$ ____________________ _____
* Lender ______________________ $________________
SOURCE OF COLLATERAL VALUATIONS
Lender ______________________ $________________ ______________________________________ AFFIDAVIT OF OWNERSHIP/AUTHORITY I _________________________________________(Name), as ________________________________(Position) of ____________________________________________________________________________(Company Name) located at ____________________________________________________________________________________ do hereby certify that the following is a list of the shareholders/partners/owners, directors, and officers of the company as of ____________________________(Date). Shareholders (Corporation) Partners (Partnership) Owners (Proprietorship) __________________________________________________________________ ____________________________%
__________________________________________________________________ ____________________________% __________________________________________________________________ ____________________________% __________________________________________________________________ ____________________________% __________________________________________________________________ ____________________________% TOTAL = 100% DIRECTORS: ____________________________________________________ ___________________________________________ ____________________________________________________ ___________________________________________ ____________________________________________________ ___________________________________________ ____________________________________________________ ___________________________________________ OFFICERS: Chairman of the Board ___________________________________________________ President ___________________________________________________ Vice President ___________________________________________________ Secretary ___________________________________________________ Treasurer ___________________________________________________ Other _________________________________ ___________________________________________________ Other _________________________________ ___________________________________________________ Other _________________________________ ___________________________________________________ Other _________________________________ ___________________________________________________
If additional space is required, use back of page
Signature: ________________________________________ Title: _______________________ Date: _______________
MANAGEMENT RESUME
(Resume is required for all stockholders of record, and for all owners, partners, officers, directors and guarantors.)
Name: _______________________________________________________________ SS#: __________________________
First Middle (Full) Maiden Last
Date of Birth: ___________________ Place of Birth: ____________________________________________________
Residence Telephone: (______)________________________ Business Telephone: (______)_________________________
Residence Address: ___________________________________________________ From: ___________ To: ___________
Street City State Zip (MM/YY) (MM/YY)
Previous Address: ____________________________________________________ From: ___________ To: ___________
Street City State Zip (MM/YY) (MM/YY)
Spouse’s Name: ________________________________________________________ SS#: __________________________
First Middle (Full) Maiden Last
If yes, give agency/position: _____________________________________
If no, give Alien Registration Number*: _______________________________________________
Have you ever been charged with or convicted of any criminal offense other than a misdemeanor involving a motor vehicle violation? Yes
If yes, furnish details in a separate exhibit.
If yes, furnish details in a separate exhibit.
If yes, furnish details in a separate exhibit.
EDUCATION NAME AND LOCATION DATES ATTENDED MAJOR DEGREE OR From To CERTIFICATE _________________________________________ __________ __________ __________________ __________________________ College MM/YY MM/YY _________________________________________ __________ __________ __________________ __________________________ High School MM/YY MM/YY Did you obtain a government guaranteed student loan for any portion of your education?
Yes No
Continuing Education Courses: ______________________________________________________________________________________ MILITARY SERVICE BACKGROUND Branch: _________________________________________ From: ___________ To: ___________ Honorable Discharge? ___________ Rank at Discharge: _____________________________ Major Assignment/Accomplishment: ____________________________________ WORK EXPERIENCE
(List chronologically, beginning with present employment)
Company Name/Address: ___________________________________________________________________________________________ From: ________ To: ________ Title: _______________________________________________________________________________ Duties: __________________________________________________________________________________________________________ Company Name/Address: ___________________________________________________________________________________________ From: ________ To: ________ Title: _______________________________________________________________________________ Duties: __________________________________________________________________________________________________________ Company Name/Address: ___________________________________________________________________________________________ From: ________ To: ________ Title: _______________________________________________________________________________ Duties: __________________________________________________________________________________________________________ Professional Associations, Offices Held, Community Involvement, etc: ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Signature: __________________________________________________________________________ Date: _______________________ Please attach your own full resume, if applicable *include a copy of Alien Registration Card (front and back) HISTORY OF BUSINESS AND BENEFITS OF LOAN (Use separate attachments to answer questions as necessary) BACKGROUND AND HISTORY OF PRINCIPALS AND COMPANY _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ NATURE OF BUSINESS, TYPES OF PRODUCTS / SERVICES _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ CUSTOMER PROFILE _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ LIST KEY CUSTOMERS LIST MAJOR COMPETITORS _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ MAJOR PAST ACCOMPLISHMENTS _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ FUTURE EXPANSION Does your company currently have plans for future expansion? ______________________________________________ Number of locations? ___________________________ Over what period of time? __________________________ How many new company locations are planned for this market? _____________________________________________ HOW WILL THIS LOAN BENEFIT YOUR COMPANY? _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ WILL THE FUNDING OF THIS LOAN CREATE NEW EMPLOYMENT OPPORTUNITIES? _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ Signature: _____________________________________________________________________ Date: ____________________________
Do you have any pending lawsuits? Yes No
Have you ever declared bankruptcy? Yes No
Are you a U.S. Citizen? Yes No
Are you employed by the U.S. Government? Yes No
AUTHORIZATION TO RELEASE INFORMATION
Lender ______________________ $________________
I/We hereby authorize the release to Nexus Financial Group, and/or any affiliates of any and all information that they may require for the purpose of a credit transaction. I/We further authorize Commercial capital of Oklahoma, div. of Nexus Financial Group and/or any affiliates to release such information to any entity they deem necessary for any purpose related to our credit transaction with them.
I/We certify that the enclosed information (plus any attachments or exhibits) is valid and correct to the best of my/our knowledge.
Signature: _________________________________________________________ Date: _____________________
Signature: _________________________________________________________ Date: _____________________
Signature: _________________________________________________________ Date: _____________________
Signature: _________________________________________________________ Date: _____________________
