Fillable Printable Small Business Loan Application Form
Fillable Printable Small Business Loan Application Form
Small Business Loan Application Form
SMALL BUSINESS LOAN APPLICATION
CHECK LIST
This checklist has been provided to assist you through the process of gathering the information for
the initial evaluation of your loan request. Complete information will be necessary to process your
application. All forms are provided herein unless otherwise noted:
1. Loan Request Form
2. Personal Financial Statement – Complete on all owners, directors, guarantors,
and stockholders with 20% or more of total stock issued. (Copy form as needed.)
3. Management Resume – provide complete resumes on all individuals referred in
#2 above. (Copy form as needed.)
4. History of Business Form
5. Estimated Project Costs
6. Certification and permission to obtain personal credit reports.
IN ADDITION, PROVIDE THE FOLLOWING:
7. Business Indebtedness Worksheet
8. Three Years Projections of Profit & Loss (Use enclosed form as a guide).
9. Interim Business Financial Statement - must be less than 60 days old.
10. Business Financial Statements and Tax Returns - Income statements, balance sheets, and time periods.
tax returns for the three prior year-end
11. Accounts Receivable and Accounts Payable Aging Schedules - as of the same date as
the income statement and balance sheet (if applicable).
12. Business Purchase Agreement (if applicable).
13. Historical Financial Information on the Business Being Acquired (if applicable)
14. Uniform Franchise Offering Circular (if applicable).
15. Executed Franchise Agreement or Letter of Approval from Franchisor (if applicable).
16. Construction Quote or Real Estate Purchase Contract for New Building or Expansion
(if applicable).
SMALL BUSINESS LOAN REQUEST FORM
APPLICANT COMPANY
Individual Name Title
Company Name Telephone
Address City
State Zip Code Email Address
Type of Entity: Corporation Partnership Proprietorship Not-for-profit LLC
Number of Employees: Existing After Loan Date Business Established
Business Tax ID Number
OWNERSHIP OF APPLICANT COMPANY
List below all owners, co-owners, and stockholders of the business.
NAME TITLE % of Ownership
Are any of the above presently under indictment, on parole, or probation? Yes No
Have any of the above ever been charged with or arrested for any criminal offense other than a minor vehicle violation
(including offenses which have been dismissed, discharged, or nolle prosequi)? Yes No
Have any of the above ever been convicted, placed on pretrial diversion, or placed on any form of probation, including
adjudication withheld pending probation for any criminal offense other than a minor vehicle violation? Yes No
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 Individual) % of OWNERSHIP
MANAGEMENT INFORMATION
Please fill in all spaces, use full first, middle, and maiden names. If an item is not applicable, please indicate so.
PERSONAL
Name SS#
First Middle Maiden Last
Date of Birth Place of Birth
Residence Address
STREET CITY STATE ZIP
Lived at this address since Telephone #: (home) (business)
Prior Address
STREET CITY STATE ZIP
Lived there from To
MONTH & YEAR MONTH & YEAR
Are you a U.S. Citizen? Yes No If no, give Alien Registration Number
EDUCATION
DATES DID YOU TYPE OF
NAME & LOCATION FROM TO MAJOR GRADUATE DEGREE
MILITARY SERVICE BACKGROUND
Branch From To Honorable Discharge?
Rank at time of Discharge
WORK EXPERIENCE (List chronologically, beginning with present employment)
Company Name/Location
From To Title
Duties
Company Name/Location
From To Title
Duties
Note: You may include additional information on a separate exhibit
HISTORY OF BUSINESS
Nature of Business
Types of Products/Services
Customer Profile
List Key Customers List Major Competitors
Major Past Accomplishments
Future Plans for Growth/Expansion
How will this loan benefit your company?
Will the funding of this loan create new employment opportunities? If so, state how:
(Use separate attachments to answer questions if necessary)
ESTIMATED PROJECT COSTS
Land acquisition $
New building construction $
Land and building acquisition $
Building improvements or repairs $
Acquisition of machinery/equipment $
Inventory purchase $
Working capital (including accounts payable) $
Acquisition of all or part of an existing business $
Payoff bank loan $
Other debt payment $
Franchise fee $
Closing costs (approximately 5% of the loan amount $
Cost overrun contingency (usually 10% of project cost, as a minimum) $
TOTAL PROJECT AMOUNT $
LESS OWN CASH/EQUITY TO BE INJECTED $< >
TOTAL LOAN REQUESTED FOR PROJECT $
NOTE:
If you are purchasing a business, please provide a copy of the buy-sell agreement, including a list of assets being
purchased and their approximate values.
If you are purchasing real estate, please provide a copy of the sales contract.
If you are constructing a building, please provide a copy of the plans and contracts/bids for work. Please note: you will
probably need to use a registered “Class A” contractor.
If you are refinancing loans, credit lines and/or credit cards, please provide the interest rate, term, monthly payment,
collateral, and any other pertinent information.
If you are purchasing a franchise, please provide a copy of the franchise agreement and Virginia franchise circular.
Comments:
PROFIT & LOSS PROJECTIONS
Applicant’s Name
YEAR #1 YEAR #2 YEAR #3
$ % $ % $ %
($000’S)
INCOME
Gross Receipts
Cost of Goods Sold
GROSS PROFIT
EXPENSES
Officer Salaries
(if a corporation)
Employee Wages
Accounting & Legal Fees
Advertising
Rent
Depreciation
Supplies
Electricity
Telephone
Interest
Repairs
Taxes
Insurance
Bad Debts
Miscellaneous
Other (explain)
TOTAL EXPENSES
NET PROFIT BEFORE TAXES
LESS: INCOME TAXES
NET PROFIT AFTER TAXES
LESS: WITHDRAWALS
(if proprietorship or partnership)
REMAINING NET PROFIT
FOR LOAN REPAYMENT
Note: please attach assumptions upon which the income and expenses were calculated.
I Certify the foregoing data represents the potential annual earnings , to the best of my knowledge.
SIGNATURE TITLE DATE
BUSINESS INDEBTEDNESS WORKSHEET
Please furnish the following information on all installment debts, credit cards,
mortgages, lines of credit or other financing. Indicate by an asterisk if the items are to
be paid by this financing request. Use additional sheets if necessary.
To Whom Payable
Original
Amount
Original
Date
Current
Balance
Interest
Rate
Maturity
Date
Monthly
Payment Security
Current
or Past
Due
Acct. #
Acct. #
Acct. #
Acct. #
Acct. #
Acct. #
Acct. #
Acct. #
Acct. #
Acct. #
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