Sba 504 Loan Approval Application Form Page 3
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9Authorization
TO RELEASE INFORMATION / PATRIOT ACT COMPLIANCE
I/We hereby authorize the release to Fountainhead Commercial Capital (Fountainhead) and/or assigns and the U.S. Small
Business Administration (SBA) (collectively) any and all information Fountainhead and/or assigns may require at any time for
any purpose related to our credit application and/or loan transaction with Fountainhead and/or assigns.
I/We hereby authorize Fountainhead to release any and all information and/or data (including but not limited to personal
and/or business financial statements, personal and/or business income tax returns, payment and/or credit history) to any
entity Fountainhead deems necessary for any purpose related to our credit application/loan transaction with Fountainhead
and/or assigns.
I/We hereby acknowledge that all loan approvals will be in writing and subject to the terms and conditions set forth in the
Loan Authorization issued by the U.S. Small Business Administration.
IMPORTANT INFORMATION
Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who applies
for credit.
Request for ID: To comply with the USA PATRIOT Act, we request that a legible copy of an unexpired government issued
photo Identification (ID) document be returned with this application for each individual applicant, guarantor or company
owner. Acceptable types of ID include: (1) US State Drivers License; (2) State ID card; (3) Military ID card; (4) Passport; or (5)
US Alien Registration card.
APPLICANT (ENTITY)
BY
ITS
GUARANTOR (PLEASE PRINT)
GUARANTOR SIGNATURE
SOCIAL SECURITY #
DATE
GUARANTOR (PLEASE PRINT)
GUARANTOR SIGNATURE
SOCIAL SECURITY #
DATE
GUARANTOR (PLEASE PRINT)
GUARANTOR SIGNATURE
SOCIAL SECURITY #
DATE
GUARANTOR (PLEASE PRINT)
GUARANTOR SIGNATURE
SOCIAL SECURITY #
DATE
In conjunction with your loan application, Fountainhead is required by federal regulation to obtain a written statement from
individuals expressing their intent to apply for joint credit. Please sign below to acknowledge your intent.
We intend to apply for joint credit.
CO-APPLICANT/CO-GUARANTOR (PRINT)
CO-APPLICANT/CO-GUARANTOR SIGNATURE
SOCIAL SECURITY #
DATE
CO-APPLICANT/CO-GUARANTOR (PRINT)
CO-APPLICANT/CO-GUARANTOR SIGNATURE
SOCIAL SECURITY #
DATE
Please return a copy of this disclosure with a legible copy of requested ID for each individual applicant, guarantor, company owner,
or co- applicant (as applicable).
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FOUNTAINHEAD COMMERCIAL CAPITAL • SBA 504 Approval • 1 8 0 0 - 770- 1 5 0 4 • V.1
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