Commercial Loan Application First State Bank of Porter

IMPORTANT APPLICATION INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one of more forms of identification to fulfill this requirement. In some instances, we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

Type

New

NOTICE -JOINT CREDIT: We intend to apply for joint credit.

Intent

Purchase

Refinance

Purpose

Collateral Type

1. LOAN APPLICATION

Loan Application General Information.

Full Legal Entity Name:

Date Entity Formed

under the laws of

Entity Type

Corporation

Trust

Partnership

Association

Limited Liability Company

Non-Profit

Sole Proprietor

Individual

Tax Identification Number

Name of Business

NAICS Code

Current Tradename(s):

Other Tradename(s) Used in the Last 10 Years:

Franchise

Franchise, in full force and without defaults, with (Name of Franchiser)

Name & Address

Type of Business

Ownership Percentage or Relationship

Type of Business

Name & Address

Ownership Percentage or Relationship

Type of Business

Name & Address

Ownership Percentage or Relationship

Principal Executive Office Address

Street Address Address Line 2 City State ZIP Code

Local Business Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax No.

Principals' Name

Address

Street Address Address Line 2 City State ZIP Code

Position Titles

Percent of Ownership

Social Security Numbers

Date of Birth

Principals' Name

Address

Street Address Address Line 2 City State ZIP Code

Position Titles

Percent of Ownership

Social Security Numbers

Date of Birth

Principals' Name

Address

Street Address Address Line 2 City State ZIP Code

Position Titles

Percent of Ownership

Social Security Numbers

Date of Birth

Principals' Name

Address

Street Address Address Line 2 City State ZIP Code

Position Titles

Percent of Ownership

Social Security Numbers

Date of Birth

Accountant Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Legal Counsel Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Business Financial Statements (Check all that apply and attach statements to this application.)

Fiscal Year:

Calendar Year:

Business Financial Statements #1

Financial Statements

Financial Statements covering from which year to which year?

Business Financial Statements #2

Business Tax/Returns

Business Tax/Returns covering from which year to which year?

Business Financial Statements #3

Personal Tax Returns

Personal Tax Returns covering from which year to which year?

2. LOAN REQUEST AND SOURCES OF REPAYMENT

Amount Requested $

Use of Proceeds (Brief Description of Intended Use):

Loan Advances

Single Advance/Closed End

Revolving Line of Credit

Construction

Other

Requested Term

3. LOAN SECURITY

The requested loan will be secured. If collateral is to be Real Estate, please complete the following:

Type of Property:

Commercial

Residential

multi-Purpose

Property Address:

Street Address Address Line 2 City State ZIP Code

Number of Units:

Appraised value $

Insurance Company

Policy#

Description of non-Real Estate Collateral:

4.LOAN GUARANTY

The requested loan will be guaranteed. (Principal with 10% Ownership.)

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Date of Birth

Social Security Number

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Date of Birth

Social Security Number

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Date of Birth

Social Security Number

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Date of Birth

Social Security Number

Legal Entity Grantor Name:

Phone

Address

Street Address Address Line 2 City State ZIP Code

Tax ID No.

Guarantor Info

Guarantor or affiliate were declared bankrupt with in the last 10 years.

There are outstanding judgements against Guarantor. (Attach Summary)

On a separate sheet, list each threatened or pending lawsuit, arbitration, or other proceeding and its amount claimed.

EQUAL CREDIT OPPORTUNITY NOTICE: 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, age (providing the applicant has the capacity to enter into a binding contract), because all of a part of the applicant’s income derives from any public assistance program, or because the applicant has in good faith exercise any right under the Consumer Credit Protection Act. The federal agency that administers compliance with the law concerning this creditor is:

FEDERAL RESERVE CONSUMER HELP CENTER PO BOX 1200 MINNEAPOLIS, MN 55480

CREDIT DENIAL NOTICE. If your gross revenues were $1,000,000 or less in your previous fiscal year, or you are requesting trade credit, a factoring agreement, or similar types of business credit in this Commercial Loan Application, and if your application for business credit is denied, you have the right to a written statement of the specific reason for the denial. To obtain the statement please contact:

First State Bank of Porter: Loan Department 230 Lincoln St., Porter, IN 46304 (219)926-2136

Within 60 days from the date, you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. The notice that follows describes additional protections extended to you.

SIGNATURES. By checking the box below, Loan Applicant submits this application and the information provided on all accompanying financial statement and schedules for the purpose of obtaining credit and represents that the information submitted is accurate and complete. Loan Applicant acknowledges that representations made in this application will be relied on by Lender in evaluating this application and, if approved, in extending credit. Loan Applicant represent that none of the parties named in this application have relied on advice from the Lender in applying for or receiving any credit. Loan Applicant acknowledges that Lender has not made any commitment to approve this application and extend credit, unless otherwise agreed to in writing. Lender is authorized to conduct any inquiries it decides are necessary to verify the accuracy of the information contained in this application and to use any reasonable method to determine the creditworthiness of the Loan Applicant. Lender is also authorized to answer any questions from others about Lender’s credit experience with the parties in this application. Loan Applicant will promptly notify Lender of any subsequent changes which would affect the accuracy of the application, and will provide all documents and information that Lender decides are necessary to complete this application. Loan Applicant authorizes Lender to retain this application, whether or not Lender approves any extension of credit. Any intentional misrepresentation of the information contained herein could result in criminal action under federal law. In addition, each individual signing below authorizes the Creditor to check their individual credit account and employment history and have a credit reporting agency prepare a consumer credit report on them.

Applicant Name

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