Fillable MEMBER BUSINESS LOAN APPLICATION (Kinecta)

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MEMBER BUSINESS LOAN APPLICATION (Kinecta)

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The MEMBER BUSINESS LOAN APPLICATION (Kinecta) form is 6 pages long and contains:

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Please Note – This loan applicaon is designed to assist in gathering essenal loan informaon. Any informaon item le blank will necessitate follow-up by the Lender and will delay loan processing.
If there are any quesons regarding the informaon requested in this applicaon, please contact your loan officer or local branch.
MEMBER BUSINESS LOAN APPLICATION
BUSINESS ACCOUNT NUMBER
EMPLOYEE
Credit Request #1
DESCRIBE THE PURPOSE OF THIS LOAN AND HOW IT WILL BENEFIT YOUR BUSINESS
AMOUNT REQUESTED
REQUESTED TERM IN YEARS
DESCRIPTION OF COLLATERAL
ESTIMATED ASSET VALUE
Credit Request #2
DESCRIBE THE PURPOSE OF THIS LOAN AND HOW IT WILL BENEFIT YOUR BUSINESS
AMOUNT REQUESTED
REQUESTED TERM IN YEARS
DESCRIPTION OF COLLATERAL
ESTIMATED ASSET VALUE
Use of Loan Proceeds
P
ROJECT ITEMS PROJECT COST
L
and & Building Acquision $
Land Acquision
$
B
uilding Construcon / Improvement (Hard Costs) $
B
uilding Construcon / Improvement (So Costs) $
D
ebt Refinance (Complete Business Debt Schedule below) $
B
usiness Acquision (List of assets & purchase agreement required) $
M
achinery / Equipment Acquision $
I
nventory $
Furniture
$
F
ixtures $
W
orking Capital $
Other (Describe)
Other: $
Total Project Cost: $
Source of Injecon
$
Total Loan Request: $
Would you like to apply for a business credit card? Yes No Are you currently a member of the credit union? Yes No
General Business Informaon
BORROWER NAME
1
FEDERAL TAX ID (EIN/TIN)
DATE OF ORGANIZATION
DBA NAME (If applicable)
BUSINESS TYPE
UNDER CURRENT MANAGEMENT SINCE
BUSINESS PHYSICAL STREET ADDRESS
CITY
STATE
ZIP CODE
BUSINESS PHONE NUMBER
CONTACT EMAIL ADDRESS
BUSINESS MAILING STREET ADDRESS
CITY
STATE
ZIP CODE
BUSINESS FAX NUMBER
WEBSITE URL
DESCRIBE THE PRIMARY NATURE OF YOUR BUSINESS AND ITS PRODUCTS OR SERVICES
INDUSTRY TYPE
NUMBER OF EMPLOYEES
Before
Loan
Aer
Loan
AVERAGE DEPOSIT BALANCES
LAST YEAR’S GROSS ANNUAL SALES
LAST YEAR’S ANNUAL NET PROFIT (PRE-TAX)
AVERAGE GROSS ANNUAL SALES FOR THE PAST 3 YEARS
Is this business the subject of a Federal, State or local citaon (including probaon),
or other acon which would preclude it from normal business operaons?
2
Yes
No
Yes
No
Is this business for profit?
Does this business restrict patronage?
Has the borrower or a principal of the borrower ever declared bankruptcy?
3
Is this business a franchise?
Have any tax liens been filed against the borrower or a principal of the borrower?
3
0
0
Please Note – This loan applicaon is designed to assist in gathering essenal loan informaon. Any informaon item le blank will necessitate follow-up by the Lender and will delay loan processing.
If there are any quesons regarding the informaon requested in this applicaon, please contact your loan officer or local branch.
Business Debt Schedule
CREDITOR NAME
ORIGINAL
AMOUNT
OUTSTANDING
BALANCE
MONTHLY
PAYMENT
INTEREST
RATE
ORIGINATION
DATE
MATURITY
DATE
STATUS
GOVERNMENT
GUARANTEED?
4
PAY OFF WITH
PROCEEDS?
1.
%
2.
%
3.
%
4.
%
5.
%
6.
%
7.
%
8.
%
9.
%
10.
%
Business Profile
LIST KEY CUSTOMERS CREDIT SALES TERMS OFFERED ON ACCOUNT GEOGRAPHICAL SALES AREAS
1.
1.
1.
2.
2.
2.
3.
3.
3.
4.
4.
4.
LIST MAJOR SUPPLIERS CREDIT SALES TERMS RECEIVED ON ACCOUNT LIST MAJOR COMPETITORS
1.
1.
1.
2.
2.
2.
3.
3.
3.
4.
4.
4.
DESCRIBE HOW PRICING OF PRODUCTS/SERVICES IS DETERMINED
DESCRIBE ADVERTISING AND PROMOTIONAL ACTIVITIES CONDUCTED TO GENERATE SALES
DESCRIBE COMPETITIVE ADVANTAGES AND MAJOR ACCOMPLISHMENTS
DESCRIBE FUTURE PLANS AND GROWTH STRATEGY (Include any idenfiable impediments)
Cerficate of Enty
Owner(s), General Partner(s), Managing Member(s), or Officer(s) |
Percentage of ownership must total 100%
|
Aach addional sheets if necessary
NAME TITLE
US CITIZEN
Y/N
5
VETERAN OR
MILITARY
6
AUTHORIZED
SIGNER Y/N
% OF
OWNERSHIP
SOCIAL SECURITY NUMBER
1.
%
2.
%
3.
%
4.
%
Conflict of Interest
Is the Applicant, or a principal of the Applicant, an employee of the credit union or its affiliates, or immediately related to an employee of the credit union or its affiliates?
Yes
No
Does the Applicant, or a principal of the Applicant, have a contractual/referral agreement with the credit union?
Yes No
Is the Applicant, or a principal of the Applicant, an employee, the spouse of an employee, a minor child or a blood relave of an employee of the Small Business Administraon
(SBA), or a blood relave of the spouse of such an individual (living in the same residence)?
Yes
No
Is an employee, owner, partner, aorney, agent, owner of stock, officer, director, creditor or debtor of the Applicant a former SBA employee, who has been separated from the
SBA for less than one year prior to the request for financial assistance?
Yes No
Is the Applicant, a principal of the Applicant, the spouse, a minor child, or a blood relave, a member of Congress, or an appointed official or employee of the legislave or
judicial branch of the Federal Government, or a blood relave of the spouse of such an individual (living in the same residence)?
Yes
No
Is the Applicant, a principal of the Applicant, the spouse, a minor child, or a blood relave, a government employee having a grade of at least GS-13 or higher, or a blood relav
e
of the spouse of such an individual (living in the same residence)?
Yes No
Is the Applicant, a principal of the Applicant, the spouse, a minor child, or a blood relave, a member or employee of a Small Business Advisory Council or a SCORE volunteer, or
a blood relave of the spouse of such an individual (living in the same residence)?
Yes
No
Please Note – This loan applica on is designed to assist in gathering essen al loan informa on. Any informa on item le blank will necessitate follow-up by the Lender and will delay loan processing.
If there are any ques
ons regarding the informa on requested in this applica on, please contact your loan officer or local branch.
Affiliate En es
Does the borrower or a principal of the borrower have controlling interest, as an owner, principal, partner or manager in any other business (including serving as a board member)? Yes No
Please provide the following informa on for each affiliate
7
en ty |
A ach addi onal sheets if necessary, any a achments must be signed and dated
AFFILIATE NAME
FEDERAL TAX ID (EIN/TIN)
TYPE OF AFFILIATION
INDUSTRY TYPE
DESCRIBE THE PRIMARY NATURE OF THE AFFILIATE BUSINESS
AVERAGE GROSS ANNUAL SALES FOR THE PAST 3 YEARS
NUMBER OF EMPLOYEES
AFFILIATE NAME
FEDERAL TAX ID (EIN/TIN)
TYPE OF AFFILIATION
INDUSTRY TYPE
DESCRIBE THE PRIMARY NATURE OF THE AFFILIATE BUSINESS
AVERAGE GROSS ANNUAL SALES FOR THE PAST 3 YEARS
NUMBER OF EMPLOYEES
Authorized Signatures and Cer ca on
Each person signing below cer es that such person is at least eighteen (18) years of age, and is an owner, shareholder, officer, director, member, manager, or partner of the Borrower with the
authority to bind the Borrower to the terms of any promissory notes or other similar instruments. Each such person authorizes Lender, and its servicer Member Business Lending, LLC, to obtain
business and consumer credit bureau reports and to exchange informa on about such person and Borrower in connec on with extensions of credit, increases, the review and collec on of the
Borrower’s credit line. Lender will provide the name and address of each credit bureau from which Lender obtained credit reports if any of the persons signing below asks for such informa on in
wri ng.
Each person signing below cer
es that all loan proceeds will be used only for business related purposes. Loan amounts may be adjusted on a case-by-case basis as determined by credit union
policies and procedures. For loan requests processed u lizing the Small Business Administra on’s 7(a) Loan Program, each person signing below understands that the applicant is not required to
obtain or pay for unwanted services; the Small Business Administra on does not require the use of an Agent for packaging or referring a loan applica on.
Each person signing below cer
es that the statements contained in this applica on are true and accurate as of the date of applica on. These statements are made for the purpose of either
obtaining a loan or guaranteeing a loan. Each such person understands that FALSE statements, including overvalua on of a security to obtain a guaranteed loan from the SBA, may result in forfeiture
of benefits and possible prosecu on by the U.S. A orney General, which may result in fines up to $10,000 and/or imprisonment for not more than five years under 18 USC1001; if submi ed to a
Federally insured ins tu on, under 18 USC 1014 by imprisonment of not more than twenty years and/or a fine of not more than $1,000,000.
SIGNATURE
PRINTED NAME
TITLE
DATE
ID TYPE
ID ISSUER
ID NUMBER
ID ISSUE DATE
ID EXPIRATION DATE
SIGNATURE
PRINTED NAME
TITLE
DATE
ID TYPE
ID ISSUER
ID NUMBER
ID ISSUE DATE
ID EXPIRATION DATE
SIGNATURE
PRINTED NAME
TITLE
DATE
ID TYPE
ID ISSUER
ID NUMBER
ID ISSUE DATE
ID EXPIRATION DATE
SIGNATURE
PRINTED NAME
TITLE
DATE
ID TYPE
ID ISSUER
ID NUMBER
ID ISSUE DATE
ID EXPIRATION DATE
1
Borrower – Name of the proprietor for Sole Proprietorships, or the name of the en ty for Partnerships, Limited Liability Companies and Corpora ons.
2
Affirma ve responses require a wri en explana on.
3
Please provide a detailed wri en explana on for each affirma ve response (explana ons must be a ached on a separate sheet).
4
All outstanding government guaranteed loans (i.e. Small Business Administra on, Department of Agriculture, Department of Veterans Affairs, Federal Deposit Insurance Corpora on, Department of Educa on and the Department of
Jus ce), including all open lines of credit, must be current and in good standing.
5
The Small Business Administra on can provide financial assistance to businesses that are at least 51% owned and controlled by persons who are not ci zens of the United States provided the persons are lawfully in the United States.
The processing procedures and the terms and condi ons will vary, depending upon the status of the owners as assigned by the United States Ci zenship and Immigra on Services (USCIS).
6
Please provide a wri en statement including the name of the military branch in which service was provided, the dates of service and the disposi on of discharge, if applicable.
7
An affiliate is a business where the borrower or a principal of the borrower has controlling interest in any other business.
Please Note – This loan applicaon is designed to assist in gathering essenal loan informaon. Any informaon item le blank will necessitate follow-up by the Lender and will delay loan processing.
If there are any quesons regarding the informaon requested in this applicaon, please contact your loan officer or local branch.
MEMBER BUSINESS LOAN APPLICATION
– PERSONAL INFORMATION
General Informaon | To be completed by each guarantor
FULL LEGAL NAME (First Name, Middle Inial, Last Name)
TITLE
US CITIZEN Y/N
SOCIAL SECURITY NUMBER
VETERAN OR MILITARY
DATE OF BIRTH
% OF OWNERSHIP
RESIDENCE PHYSICAL STREET ADDRESS
CITY
STATE
ZIP CODE
RESIDENCE PHONE
MOBILE PHONE
EMAIL ADDRESS
Have you ever declared bankruptcy?
Yes No
Are you currently involved in any lawsuits/ligaons?
Yes No
Are you past due on any tax obligaons?
Yes No
Have you ever defaulted on any federally assisted loan?
Yes No
Personal Financial Statement
ASSETS
(Omit Cents)
LIABILITIES
(Omit Cents)
C
ash on hand & in Banks
$
A
ccounts Payable $
S
avings Accounts
$
N
otes Payable to Banks and Others (e.g. Credit Cards) (Describe in Secon 6) $
R
eal Estate (Describe in Secon 2)
$
I
nstallment Account (Auto) Sum of Monthly Payments $
$
A
utomobiles – Total Present Value (Describe in Secon 3)
$
I
nstallment Account (Other) Sum of Monthly Payments $
$
I
RA or Other Rerement Accounts (Describe in Secon 3)
$
Mo
rtgages on Real Estate (Describe in Secon 2) $
A
ccounts & Notes Receivable (Describe in Secon 3)
$
U
npaid Taxes (Describe in Secon 7) $
O
ther Personal Property (Describe in Secon 3)
$
O
ther Liabilies (Describe in Secon 7) $
O
ther Assets (Describe in Secon 3)
$
L
oan on Life Insurance $
S
tocks and Bonds (Describe in Secon 4)
$
Total Liabilies $
L
ife Insurance – Cash Surrender Value Only (Describe in Secon 5)
$
Net Worth $
Total
$
Total $
SECTION 1 | Sources of Income
Conngent Liabilies
S
alary
$
A
s Endorser or Co-Maker $
N
et Investment Income
$
L
egal Claims & Judgments $
R
eal Estate Income
$
P
rovision for Federal Income Tax $
Other Income
(Describe below)
*
$
Other Special Debt
$
DESCRIPTION OF OTHER INCOME IN SECTION 1
*Alimony or child support payments need not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income
SECTION 2 | Real Estate Owned |
List each parcel separately. Aach addional sheets if necessary, any aachments must be idenfied as a part of this statement and signed and dated
PROPERTY A
TYPE OF REAL ESTATE
STREET ADDRESS
CITY
STATE
ZIP CODE
NAME(S) ON TITLE
DATE PURCHASED
ORIGINAL COST
PRESENT MARKET VALUE
NAME OF MORTGAGE HOLDER MORTGAGE ACCOUNT NUMBER MORTGAGE BALANCE PAYMENT AMOUNT STATUS
1.
2.
PROPERTY B
TYPE OF REAL ESTATE
STREET ADDRESS
CITY
STATE
ZIP CODE
NAME(S) ON TITLE
DATE PURCHASED
ORIGINAL COST
PRESENT MARKET VALUE
NAME OF MORTGAGE HOLDER MORTGAGE ACCOUNT NUMBER MORTGAGE BALANCE PAYMENT AMOUNT STATUS
1.
2.
PROPERTY C
TYPE OF REAL ESTATE
STREET ADDRESS
CITY
STATE
ZIP CODE
NAME(S) ON TITLE
DATE PURCHASED
ORIGINAL COST
PRESENT MARKET VALUE
NAME OF MORTGAGE HOLDER MORTGAGE ACCOUNT NUMBER MORTGAGE BALANCE PAYMENT AMOUNT STATUS
1.
2.
%
0
0
0
0
Please Note – This loan applicaon is designed to assist in gathering essenal loan informaon. Any informaon item le blank will necessitate follow-up by the Lender and will delay loan processing.
If there are any quesons regarding the informaon requested in this applicaon, please contact your loan officer or local branch.
SECTION 3 | Automobiles, Rerement Accounts, Accounts and Notes Receivable, Other Personal Property and Other Assets |
Aach addional sheets if necessary, any aachments must be signed and dated
DESCRIPTION OF ASSET (For vehicles include Year, Make and Model)
PLEDGED AS
SECURITY? Y/N
NAME OF LIENHOLDER LIEN AMOUNT TERMS OF PAYMENT
DELINQUENT?
Y/N
1.
2.
3.
4.
DESCRIPTION OF DELINQUENCY (If applicable)
SECTION 4 | Stocks and Bonds| Aach addional sheets if necessary, any aachments must be idenfied as a part of this statement and signed and dated
NAME OF SECURITIES
NUMBER OF
SHARES
COST
MARKET VALUE
QUOTATION/EXCHANGE
DATE OF
QUOTATION/EXCHANGE
TOTAL VALUE
1.
2.
3.
4.
SECTION 5 | Life Insurance |
Aach addional sheets if necessary, any aachments must be idenfied as a part of this statement and signed and dated
NAME OF INSURANCE COMPANY FACE VALUE
CASH SURRENDER
VALUE
BENEFICIARY(IES)
1.
2.
SECTION 6 | Notes Payable to Banks and Others |
Aach addional sheets if necessary, any aachments must be idenfied as a part of this statement and signed and dated
NAME OF NOTEHOLDER(S)
ORIGINAL
BALANCE
CURRENT
BALANCE
PAYMENT
AMOUNT
FREQUENCY
(Monthly, Etc.)
HOW SECURED OR ENDORSED (Type Of Collateral)
1.
2.
3.
4.
SECTION 7 | Unpaid Taxes and Other Liabilies |
Aach addional sheets if necessary, any aachments must be idenfied as a part of this statement and signed and dated
TYPE OF LIABILITY TO WHOM PAYABLE DUE DATE AMOUNT DUE ADDRESS OF PROPERTY TO WHICH TAX LIEN APPLIES (If applicable)
1.
2.
3.
4.
Cerficaon
Each person signing below authorizes Lender, and its servicer Member Business Lending, LLC, to make inquiries as necessary to verify the accuracy of the statements made and to determine my
creditworthiness. I cerfy under penalty of criminal prosecuon that all informaon on this form, and any addional supporng informaon submied with this form, is true and complete to the best
of my knowledge, as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. Each person signing below understands that FALSE
statements may result in forfeiture of benefits and possible prosecuon.
SIGNATURE
PRINTED NAME
SOCIAL SECURITY NUMBER
DATE
SIGNATURE OF SPOUSE
PRINTED NAME OF SPOUSE
SOCIAL SECURITY NUMBER OF SPOUSE
DATE
$ 0
$ 0
$ 0
$ 0
Please Note – This loan applicaon is designed to assist in gathering essenal loan informaon. Any informaon item le blank will necessitate follow-up by the Lender and will delay loan processing.
If there are any quesons regarding the informaon requested in this applicaon, please contact your loan officer or local branch.
MEMBER BUSINESS LOAN APPLICATION
– MANAGEMENT RESUME
General Informaon | To be completed by each principal of the Applicant and each guarantor
FULL LEGAL NAME (First Name, Middle Inial, Last Name)
CURRENT RESIDENCE PHYSICAL ADDRESS
PREVIOUS RESIDENCE PHYSICAL ADDRESS
STREET ADDRESS
STREET ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
Educaon
COLLEGE OR TECHNICAL TRAINING | List most recent degree first |
Aach addional sheets if more space is required
NAME OF INSTITUTION
DEGREE/CERTIFICATE
LOCATION
DATES ATTENDED
MAJOR
From: To:
NAME OF INSTITUTION
DEGREE/CERTIFICATE
LOCATION
DATES ATTENDED
MAJOR
From: To:
NAME OF INSTITUTION
DEGREE/CERTIFICATE
LOCATION
DATES ATTENDED
MAJOR
From: To:
Skills
PLEASE PROVIDE A SHORT NARRATIVE OF SKILLS RELATED TO THE PRIMARY INDUSTRY OF YOUR BUSINESS |
Aach addional sheets if more space is required
Work Experience
LIST MOST RECENT EMPLOYER FIRST | aach addional sheets if more space is required
NAME OF COMPANY
POSITION/TITLE
STREET ADDRESS
CITY
STATE
ZIP CODE
DATES EMPLOYED
From: To:
PLEASE PROVIDE A SHORT NARRATIVE OF DUTIES AND RESPONSIBILITIES AS ASSIGNED
NAME OF COMPANY
POSITION/TITLE
STREET ADDRESS
CITY
STATE
ZIP CODE
DATES EMPLOYED
From: To:
PLEASE PROVIDE A SHORT NARRATIVE OF DUTIES AND RESPONSIBILITIES AS ASSIGNED
NAME OF COMPANY
POSITION/TITLE
STREET ADDRESS
CITY
STATE
ZIP CODE
DATES EMPLOYED
From: To:
PLEASE PROVIDE A SHORT NARRATIVE OF DUTIES AND RESPONSIBILITIES AS ASSIGNED
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MEMBER BUSINESS LOAN APPLICATION (Kinecta)

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Completed 25 March 2021

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