Sba 504 Loan Application Form (Page 3 of 5) in pdf

Sba 504 Loan Application Form Page 3

SBA 504 LOAN REQUEST FORM

APPLICANT COMPANY:

Company Name ____________________________________________ Phone _____________________

Contact Name __________________________________________________________________________

Address ______________________________________ City ____________ State ____ Zip __________

Current number of employees _____ FT _____ PT Number of jobs to be created _____ FT _____ PT

E-Mail Address _________________________________________________________________________

1) Has the business, or any principals of the business, been involved in a bankruptcy? _____ Yes

_____ No

2) Is the business, or any principals of the business, currently involved in a lawsuit or pending litigation?

______ Yes _____No

3) Does any principal of the business have delinquent and/or past due child support? _____ Yes _____ No

4) Has the business or any principals of the business, received previous government financing? (SBA, Rural

Development, VA, FHA, etc.)

______ Yes _____ No If yes, please complete the following:

Federal

Loan Program

Original

Current

Borrower Name

Source

Type

Loan #

Balance

Status

5) Has the business or any principals of the business defaulted on any previous government financing? ____Yes ____No

Sba 504 Loan Application Form Page 3