Fillable BUSINESS LOAN APPLICATION

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BUSINESS LOAN APPLICATION

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BUSINESS LOAN APPLICATION
Legal Name of Business Applicant Proprietorship Limited Partnership LLC
General Partnership C Corporation S Corporation
DBA or Trade Name (if different) Year Business
Established
Current Owner
Since
# Locations # Employees
Nature of Business Business Telephone
( )
Business FAX Federal Tax ID Number
Business Location (Street, City, Zip Code)
Total Loan Amount Requested $____ __
____
Mailing Address (if different)
Loan Purpose:
____ Purchase Fixed Assets
____ Inventory / Receivables
____ Purchase Real Estate
____ Leasehold Improvements
____ Real Estate Construction
__
__ Debt Restructuring
__
__ Other ________________
Requested Amount:
$______________
$______________
$______________
$______________
$______________
$_________
_____
$___
__
Collateral Value:
$______________
$______________
$______________
$______________
$______________
$______________
$______________
E-Mail Address Web Site Address
Are you applying for credit from any other source? YES NO
If yes, from where?
Do you currently have a relationship with Coast Central Credit Union?
Yes No
If not, how were you referred to Coast Central Credit Union?
CPA Attorney Loan Broker __________________________
What will be your Primary Source of Repayment? What will be your Secondary Source of Repayment?
PRINCIPALS / OWNERS (Please provide a Personal Financial Statement for each name listed below.)
Name Ownership Title Name Ownership Title
% %
% %
% %
FINANCIAL RELATIONSHIPS (Please list only your business accounts.)
Financial Institution Account Number
Business
Current Balance
For Credit Union Use
Checking Savings Loan Ave. Bal.
Product
Code
$ $
$ $
BUSINESS / TRADE REFERENCES (Please list your major suppliers or references.)
Name Address Name of Contact Phone Number
COMPETITION (Please list the names of your major competition and business lines in which they compete
Name Business Line Name Business Line
MISCELLANEOUS (Please provide details below if you answer YES to any of the following questions.)
Is the business a party to any claim or
lawsuit?
YES
NO
Has the business ever declared bankruptcy?
YES NO
Chapter _________ Date of Filing _________
Is the business an endorser, guarantor, or co-maker for obligations
not listed on its financial statements?
YES NO
If YES, please indicate
Total contingent liability. $_________________________
Are there any delinquent FICA or Sales
Taxes?
YES NO
Are Accounts Receivable or Inventory
currently pledged as collateral?
YES
NO
Does the business owe any taxes for years prior to the
current year?
YES NO
If yes, amount $___________________
DETAILS:
The undersigned certifies that all statements in this Application and on each document required to be submitted in connection herewith, including federal income tax returns, are
true, correct and complete. The undersigned authorizes Coast Central Credit Union to make such inquiries and gather such information as the Credit Union deems necessary and
reasonable concerning any information provided to the Credit Union on this Application or on any such required document, including inquiries to the Internal Revenue Service. The
undersigned, further, agrees to notify the Credit Union promptly of any material change in any such information.
_________________________________________________________ _____________________________________________________ _______________________
SIGNATURE (APPLICANT) TITLE DATE
EXHIBIT A
IMPORTANT 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
(provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good
faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning Coast Central Credit Union is the Comptroller of the
Currency, Consumer Examinations Division, Washington, D.C. 20219
Rev 12-13-06 DJS
Rev 12-13-06 DJS
FINANCIAL DOCUMENT CHECKLIST
Please provide the following documenta
tion with your completed and signed loan application:
BUSINESS INCOME TAX RETURNS FOR THE MOST RECENT THREE YEARS:
BUSINESS FISCAL YEAR-END FINANCIAL STATEMENTS (including Balance Sheet and Profit & Loss
Statement)
FOR THE MOST RECENT YEARS:
MOST CURRENT INTERIM BUSINESS PROFIT AND LOSS STATEMENT
CURRENT PERSONAL FINANCIAL STATEMENTS FROM ALL PRINCIPALS OF THE BUSINESS (dated within
three months)
PERSONAL TAX RETURNS FOR THE MOST RECENT THREE YEARS FROM ALL PRINCIPALS OF THE
BUSINESS (please include all applicable schedules, including Schedule K1(s) for Partnership Interests)
PARTNERSHIP AGREEMENT (for Partnership)
ARTICLES OF INCORPORATION (for Corporation)
ARTICLES OF ASSOCIATION (for LLC)
FICTITIOUS NAME STATEMENT (if applicable)
NON PROFIT ORGANIZATION ADDENDUM (for Non Profits)
COPY OF PURCHASE ORDER AND COST BREAKDOWN, IF FUNDS ARE TO BE U
SED TO PURCHASE FIXED
ASSETS (equipment, vehicles, fixtures, etc.)
FOR NEW BUSINESS MEMBERS: BUSINESS HISTORY / BUSINESS PLAN / RESUME OF KEY PERSONNEL
IF THIS LOAN IS TO BE SECURED BY REAL ESTATE, PLEASE INCLUDE:
FOR INCOME PROPERTY: COPIES OF LEASES; AND, IF HELD IN SEPAR
ATE PARTNERSHIP OR
CO
RPORATION, 2 YEARS TAX RETURNS
FOR PURCHASE MONEY TRANSACTIONS: COPY OF DEPOSIT RECEIPT AND PROJECTED RENTAL
INCOME/EXPENSES
FOR REFINANCE OF SECOND MORTGAGES: COMPLETED AND SIGNED “VERIFICATION OF MORTGAGE”
FORM
IF THIS LOAN IS FOR REAL ESTATE CONSTRUCTION, PLEASE INCLUDE:
PLANS, DESCRIPTION OF MATERIALS, AND COST BREAKDOWN
CONTRACTOR UNDERWRITING PACKAGE (Financial Statement, Resume, References) IF CONTRACTOR HAS
NOT BEEN PREVIOUSLY APPROVED BY COAST CENTRAL CREDIT UNION
P
lease contact Member Business Services at (707) 445-8801 x1620 with any questions you may have. Thank you for
selecting Coast Central Credit Union for your borrowing needs. We look forward to assisting you with your loan
request.
EXHIBIT B
IMPORTANT NOTICE: if your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please write to Coast
Central Credit Union, 2650 Harrison Avenue, Eureka, CA 95501, or call (800) 974-9727 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.
PERSONAL FI
NANCIAL STATEMENT
IMPORTANT: Read these directions before completing the Statement.
If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets
of another person as the basis for repayment of the credit requested, complete only Sections 1 and 3.
If you are applying for joint credit with another person, complete all Sections providing information in Section 2 about the joint
applicant.
If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the
income or assets of another person as a basis for repayment of the credit requested, complete all sections, providing information in
Section 2 about the person upon whose alimony, support or maintenance payments or income or assets you are relying.
If this statement relates to your guaranty of the indebtedness of other person(s), firm(s) or corporation(s), complete Sections 1 and 3.
To: COAST CENTRAL CREDIT UNION
SECTION 1—INDIVIDUAL INFORMATION (TYPE OR PRINT) SECTION 2—OTHER PARTY INFORMATION
Name Name
Residential Address Residential Address
City, State & Zip City, State & Zip
Social Security Number -- -- Social Security Number -- --
Date of Birth / / Date of Birth / /
Position or Occupation Position or Occupation
Business Name Business Name
Business Address Business Address
City, State & Zip City, State & Zip
H Phone ( ) - Bus Phone ( ) - H Phone ( ) - Bus Phone ( ) -
SECTION 3—STATEMENT OF FINANCIAL CONDITION:
AS OF: (DATE) _______ / _______ / _______
ASSETS IN DOLLARS
(Do not include assets of doubtful value) (Omit cents)
LIABILITIES IN DOLLARS
(Omit cents)
Cash with Coast Central Credit Union - Sched A Revolving debt outstanding
Cash on hand and in Other Fin Inst - Sched A Unpaid income tax
U.S. Gov’t./Marketable Securities - Schedule B Other unpaid taxes and interest
Cash Value-Life Insurance—Schedule C Notes Payable (other than real estate)--Sched F
Real Estate Owned—Schedule D Real Estate Mortgages Payable—Schedule D
Notes / Loans Receivable Vehicle/RV loans
Retirement Accounts / IRAs Other Debts—itemize
Vehicles and RVs
Equipment
Non-marketable Securities—Schedule E
Personal Property TOTAL LIABILITIES
Other Assets—itemize NET WORTH (Total Assets minus Total Liabilities)
TOTAL ASSETS TOTAL LIABILITIES AND NET WORTH
SOURCES OF INCOME FOR THE YEAR ENDED
_
_________
_
PERSONAL INFORMATION
Salary, Bonuses and Commissions $_______________
Do you have a will?
If so, name of executor.
Dividends $_______________
Are you a partner or officer in any other venture? If so, describe.
Real Estate Income $_______________
Are you obligated to pay alimony, child support or separate
maintenance payments?_______ If so, describe.
Other Income (Alimony, child support, or separate maintenance. Income
need not be revealed if you do not wish to have it considered as a basis for
repaying this obligation.)
$_______________
Are any assets pledged other than as described on schedules?
______ If so, describe.
TOTAL INCOME $_______________
Income tax settled through (date)
Revised 1-7-08 DJS
Do you have any contingent liabilities? If so, describe.
_________________________________________________
_________________________________________________
_________________________________________________
Are you a defendant in any suits or legal actions? _______________
Personal bank accounts carried at: ___________________________
Have you ever been declared bankrupt? ______ If so, describe on
separate sheet.
As endorser, co-maker or guarantor? $_____________
On leases or contracts? $_____________
Are any of your assets held in a Trust? _______ If so, please describe,
and provide a copy of the Trust Declaration Page. ________________
________________________________________________________
________________________________________________________
Legal claims / other special debt $_____________
Amount of contested income tax liens $_____________
PLEASE COMPLETE SCHEDULES BELOW (attach separate sheet if needed)
SCHEDULE A—CASH DEPOSIT ACCOUNTS
ACCOUNT TITLE FINANCIAL INSTITUTION ACCOUNT TYPE AVERAGE BALANCE
ACCOUNT TITLE
FINANCIAL INSTITUTION ACCOUNT TYPE
AVERAGE BALANCE
$ $
$ $
SCHEDULE B—U.S. GOVERNMENT AND MARKETABLE SECURITIES
NUMBER OF SHARES OR FACE VALUE
(BONDS)
DESCRIPTION IN NAME OF
ARE THESE
PLEDGED?
MARKET VALUE
$
$
$
SCHEDULE C—LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE
NAME OF INSURANCE COMPANY OWNER OF POLICY BENEFICIARY FACE AMOUNT OF POLICY LOANS ON POLICY
CASH SURRENDER
VALUE
$ $ $
$ $ $
SCHEDULE D—REAL ESTATE OWNED
ADDRESS & TYPE OF PROPERTY TITLE IN NAME OF DATE ACQUIRED
PERCENT
OWNERSHIP
AMOUNTS BASED ON % OF OWNERSHIP INTEREST
ORIGINAL COST
MARKET VALUE MORT.
AMOUNT
PMT.
AMOUNT
% $ $ $ $
% $ $ $ $
% $ $ $ $
% $ $ $ $
% $ $ $ $
SCHEDULE E—NON-MARKETABLE SECURITIES
NUMBER OF
SHARES
DESCRIPTION IN NAME OF
ARE THESE
PLEDGED?
SOURCE OF VALUE VALUE
$
$
SCHEDULE F—NOTES PAYABLE (OTHER THAN REAL ESTATE)
NAME & ADDRESS OF LENDER SECURED/UNSECURED? ORIGINAL DATE
HIGH CREDIT
CURRENT BALANCE
PMT
AMT
$ $ $
$ $ $
$ $ $
SCHEDULE G—BANKS OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED
NAME & ADDRESS OF LENDER CREDIT IN THE NAME OF
SECURED
/
UNSEC?
ORIGINAL DATE HIGH CREDIT CURRENT BALANCE PMT AMT
$ $ $
$ $ $
$ $ $
THE INFORMATION CONTAINED IN THIS STATEMENT IS PROVIDED FOR THE PURPOSE OF OBTAINING OR MAINTAINING CREDIT WITH YOU ON
BEHALF OF THE UNDERSIGNED, OR PERSONS, FIRMS OR CORPORATIONS IN WHOSE BEHALF THE UNDERSIGNED MAY EITHER SEVERALLY
OR JOINTLY WITH OTHERS, EXECUTE A GUARANTY IN YOUR FAVOR. EACH UNDERSIGNED UNDERSTANDS THAT YOU ARE RELYING ON THE
INFORMATION PROVIDED HEREIN (INCLUDING THE DESIGNATION MADE AS TO OWNERSHIP OF PROPERTY) IN DECIDING TO GRANT OR
CONTINUE CREDIT. EACH UNDERSIGNED REPRESENTS AND WARRANTS THAT THE INFORMATION PROVIDED IS TRUE AND COMPLETE AND
THAT YOU MAY CONSIDER THIS STATEMENT AS CONTINUING TO BE TRUE AND CORRECT UNTIL A WRITTEN NOTICE OF A CHANGE IS GIVEN
TO YOU BY THE UNDERSIGNED. YOU ARE AUTHORIZED TO MAKE ALL INQUIRIES YOU DEEM NECESSARY TO VERIFY THAT ACCURACY OF
THE STATEMENTS MADE HEREIN, AND TO DETERMINE MY/OUR CREDITWORTHINESS. YOU ARE AUTHORIZED TO ANSWER QUESTIONS
ABOUT YOUR CREDIT EXPERIENCES WITH ME/US.
Signature (Individual) Dated Signature (Other Party) Dated
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BUSINESS LOAN APPLICATION

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Completed 10 March 2022

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