Loan Request
Amount of Loan:
________________________________
Purpose of Loan:
________________________________
(if new store purchase, include purchase price)
Term:
5 Years _____ 7 Years _____ (
)
check desired term
Rate Option:
Floating ___ Fixed ____ (
)
check desired rate option
Line of Credit:
___ Floating
Multi Advance/Term ___ Floating
Store Information
If you operate more than one store, please fill out the additional sheets attached.
STORE ADDRESS: ____________________________________________________
PURCHASE DATE: __________ OPEN DATE: _____________
NATIONAL STORE NUMBER: ___________________________
FRANCHISE LETTER AGREEMENT DATE: _____ LEASE EXPIRATION DATE: ____
Business References
BANK NAME (Business): _________________________________________________
ADDRESS: ____________________________________________________________
BANK NAME (Personal): _________________________________________________
ADDRESS:_____________________________________________________________
BUSINESS INSURANCE: ___________________TELEPHONE NUMBER: __________
ACCOUNTANT: ___________________________TELEPHONE NUMBER:__________
Questions About Your Business
1. Are there any obligations not listed on the financial statements of the companies for
which your business is an endorser, guarantor, or a co-signor? ____________________
2. Are you or any of your affiliates party to any claim or lawsuit? ___________________
3. Have you or any of your affiliates ever declared bankruptcy? ____________________
4. Do you or any of your affiliates owe or dispute any taxes?
____________________
If you answered “yes” to any of the questions above, please provide a brief explanation.