Sba Loan Application Page 3
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7SBA Loan Application
Qualification Profile
Name of Applicant/ Business:_________________________
DBA, if applicable:_______________________
Physical Address:____________________________________________ Phone:____________________________
Mailing Address:____________________________________________ Federal Tax ID:______________________
Type of Business (Industry & Type)_________________________________________________________________
Form of Business Entity:
C-Corp
S-Corp
Partnership
LLC
LLP
Other:_____________________
Number of Employees: at time of application:_______ if loan is approved:_______ affiliate employees:________
Do you or any owner of 20% or more of the business have a controlling interest in another business?
No
Yes, number of employees:______________
Management and Owners
(attach additional sheets if needed)
Name:_______________________________________________ Percentage of Ownership:__________________
Home Address:________________________________________ Social Security Number:___________________
Email Address:________________________________________________________________________________
Name:_______________________________________________ Percentage of Ownership:__________________
Home Address:________________________________________ Social Security Number:___________________
Email Address:________________________________________________________________________________
Have any principal owners had SBA or other Government financing:
Yes
No
If Yes, original amount____________, current balance_____________, bank______________, status___________
Are any of the majority owners:
Female
Veteran
Disabled
Minority, specify_______________
(This information is used to determine eligibility for special loan and technical assistance
Length of time in business:
Start –up
1-4 yrs
5-9 yrs
10+yrs Date Established_____________
Have any managers or owners ever been charged with or convicted of any criminal offense other then a minor motor
vehicle violation?
No
Yes, attach details
Primary Contact: _____________________________________ Phone:___________________________________
Applicant’s Signature:_________________________________ Date:____________________________________
Co-Applicant’s Signature:______________________________ Date:____________________________________
(if you are requesting the financial accommodation jointly)
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