1. Are you a United States citizen?
If you are NOT a citizen, are you a legal permanent resident?
2. Have you been arrested in the past six months for any criminal offense?
3. Are you presently on probation, subject to an indictment, criminal information,
arraignment, or other means by which formal criminal charges are brought in any
4. For any criminal offense – other than a minor vehicle violation – have you ever:
a) been convicted; b) plead guilty; c) plead no contest; d) been placed on pretrial
diversion; or e) been placed on any form of parole or probation (including probation
5. Do you currently have any federal debt? (SBA loans, student loans, and/or
6. Have you or your company defaulted, settled or compromised a government loan,
federal taxes, or otherwise caused an agency of the government to sustain a loss?
7. Have you been involved in bankruptcy or insolvency proceedings?
8. Are you or your business involved in any pending lawsuits?
9. Have you been 60+ days delinquent in court-ordered child support payments?
By submitting electronically, I/We authorize TMC/SBA to make inquiries as necessary to verify the accuracy of
these statements and to determine creditworthiness. I/We certify that the information provided is true and
accurate as of the stated date. These statements are made for the purpose of obtaining a loan.
Are you a veteran of the U.S. Armed Forces? (If yes, ask about our Vet Loan Program)
All applicants with 20% ownership (and greater) of the company or real estate must complete this form.