Fillable Small Business Loan Application - Seed (Page 4 of 4) in pdf

PRINCIPALS/OWNERS

(Must be completed by anyone with 20% or more ownership)

Full Name

Title

Address

Social Security Number

Date of Birth

Percentage of Ownership

Home Telephone

Place of Birth

U.S. Citizen? Yes_____ No_____ Alien Registration Number

Veteran*

Non-Veteran*

Male*

Female*

Caucasian*

African American*

Puerto Rican*

Native American*

Hispanic*

Asian/Pacific Islander*

Eskimo/Aleut*

Portuguese*

Other(Explain)*

*This data is collected for statistical purposes. It has no bearing on credit decisions. Disclosure is voluntary.

PERSONAL FINANCIAL STATEMENT

Please copy this page and fill out the information above for additional principals/owners. Also, please fill out a

Personal Financial Statement (Form 413) for each principal/owner. SEED will accept information on a bank form.

Form 413 is attached for your convenience.

ELIGIBILITY AND DISCLOSURES



Are you or your business involved in any pending lawsuits? Yes ____ No ____. If yes, provide details separately.



Affiliates: Do you or the applicant business have any interest in any other business as owner, principal, partner or manager?

Yes ____ No ____. If yes, please provide details separately.



Are you: (a) presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal

charges are brought in any jurisdiction? Yes ____ No ____ or (b) have you been arrested in the past six months for any criminal

offense? Yes ____ No ____ or (c) for any criminal offense – other than a minor vehicle violation – have you ever: 1) been

convicted; 2) plead guilty; 3) plead nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole

or probation (including probation before judgment), Yes ____ No ____.



Are you current on all your debts, and payroll, federal, state and property taxes? Yes _________ No ____________. Explain

________________________________________________________________________________________________________



Has your business or you personally ever declared bankruptcy? Yes __________ No __________.



(Please explain details in a separate letter)

If yes, when and date of discharge______________________________

SIGNATURE

I/We authorize SEED to make inquiries as necessary to verify the accuracy of the statements made and to determine

my/our credit worthiness. Everything that has been stated in this application is correct to the best of my/our knowledge.

I/We further promise that the proceeds of this loan will be used solely for the purposes outlined above and will not be used

for any other purpose. I/We understand that you will retain this application whether or not it is approved. You are

authorized to check my/our credit history and to answer questions about my/our credit history with you. I/We agree to

notify you if there are any material changes in the information disclosed in this application or any accompanying

statements.

Print Name_________________________________________ Date_________________________________________

Signature __________________________________________ Title _________________________________________

Print Name_________________________________________ Date_________________________________________

Signature __________________________________________ Title _________________________________________

If Corporation, Attested By: ___________________________________________________________________________

Signature of Corporate Secretary

Please sign and mail to SEED Corp., 80 Dean Street, Taunton, MA with

a $50.00 non-refundable check made payable to SEED Corporation.

SEED is an equal opportunity lender.

Small Business Loan Application - Seed Page 4

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