BUSINESS LOAN APPLICATION
A. GENERAL INFORMATION
Legal name of applicant
Key contact
DBA (if applicable)
Fiscal year end
Email address
Business phone
Business fax
(
)
(
)
Management’s years of experience in same line of business
Gross annual business revenue
Nature of business
Date business established
Number of employees
Tax I.D. number
State in which organized
Business street address (no P.O. boxes)
City
State
Zip
County
Business mailing address (if different than above)
City
State
Zip
County
Business Structure:
Corporation
“LLC”
Partnership
Unincorporated Assoc.
Non-Profit
B. CREDIT INFORMATION
Type of credit requested
Secured Term Loan
Indicate number of years requested for repayment
1
2
3
4
5
Proposed use of loan proceeds
$
Payment type and date requested
Monthly
Line of Credit
No
Quarterly
Annually
Other:
Beginning on the
day of the month of
Automatic payments
$
Please deduct my payment from membership
Commercial Real Estate Loan**
Owner occupied
Account #
Non-owner or investment real estate
Purchase
$
Overdraft protection: indicate membership
Refinance
**HMDA: Is application for a loan to purchase, refinance, or improve a
residential dwelling, or improve the real property on which a dwelling** is
located?
Yes – If applicant is a natural person, complete Government
Monitoring Information form (SO767) (see attached)
No
Other
Amount requested
Other
Increase existing line?
Yes*
*Amount of existing line: $
Sole Proprietorship
N/A – Line of credit
**Dwelling means a residential structure, whether or not attached to real property, and
includes principal residences, vacation or second homes, rental properties, mobile and
manufactured homes, and multi-family structures (such as apartment buildings).
Account #
Description of collateral (address for real property)
Collateral value $
Basis for value:
Appraisal
Tax assessed
Cost
Book value
C. SIGNATURES
The Undersigned certify that the information provided on and with this form, including financial statements, is complete and correct and that we are authorized to execute this
form on behalf of the Applicant. Applicant authorizes Central Willamette Community Credit Union (“Central Willamette”) to obtain credit reports, and to release credit
information to other including, without limitation, companies affiliated with Central Willamette, regarding Applicant from time to time. Applicant also authorizes Central
Willamette to obtain copies of its tax returns and information fro the IRS and other taxing authorities, and agrees to execute whatever form Central Willamette requests to
obtain such information. In addition, Applicant authorizes Lender to cause such UCC financing statements to be filed in such form and in such jurisdictions and encumbering
such assets as Lender or its counsel deem appropriate in their sole and absolute discretion.
Signature
Print Name
Title
% Owner
Date
Signature
Print Name
Title
% Owner
Date
Page 1 of 3
Form SO767
INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the Federal government for certain types of loans related to a dwelling in
order to monitor the lender’s compliance with equal credit opportunity, fair housing, and home mortgage disclosure
laws. You are not required to furnish this information, but are encouraged to do so. You may select one or more
designations for “race”. The law provides that a lender may not discriminate on the basis of this information, or on
whether you choose to furnish it. However, if you choose not to furnish the information and you have made this
application in person, under federal regulations the lender is required to note ethnicity, race and sex on the basis of
visual observation or surname.
If you do not wish to furnish the information, please check below.
Applicant
Co-Applicant
I do not wish to furnish this information.
I do not wish to furnish this information.
Ethnicity
Ethnicity
Hispanic or Latino
Hispanic or Latino
Not Hispanic or Latino
Not Hispanic or Latino
Race or National Origin
Race or National Origin
American Indian or Alaskan Native
American Indian or Alaskan Native
Asian
Asian
Black or African American
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian or Other Pacific Islander
White
White
Sex
Sex
Female
Female
Male
Male
Signature
Date
Date
Signature
Print or Type Name
Print or Type Name
FOR CREDIT UNION USE ONLY:
Complete this section ONLY if applicant or co-applicant elects not to provide this information and the
application is taken in person:
Noted Ethnicity: Applicant ___________________
Noted Race:
Applicant ___________________
Noted Sex:
Applicant ___________________
Co-Applicant _______________________
Co-Applicant _______________________
Co-Applicant _______________________
I hereby certify that I have noted this information based on visual observation or surname.
_________________________________
Signature of Credit Union Employee
Print Name of Credit Union Employee
Page 2 of 3
Date
BUSINESS LOAN APPLICATION
In order to help us process your application quickly, please provide the following information
with the completed Business Loan Application:
Information for the business:
• Current Balance Sheet and Income Statement
• Business Debt Schedule(s)
• Most recent three years tax returns, including all schedules & attachments
signed
• Organizational Documents (as applicable)
o Articles of Incorporation & By-Laws
o Partnership Operation Agreement
o LLC Operating Agreement
o Trust Agreement
Information for individuals (all individuals with ownership in the business):
•
•
Current personal financial statement
Most recent three years tax returns, including all schedules & attachments,
signed
In addition, please include any pertinent information on the collateral being offered, such as:
Real Estate:
• Description of property and improvements
• Copies of all leases/rental agreement
• Copy of any previous appraisal and/or environmental reports
• Copy of the sale/purchase agreement
• Copy of current county valuation
Vehicle or Equipment:
• Make, model and serial number
• Purchase invoice
• Current Valuation
Accounts Receivable:
• Aging as of the end of the most recent fiscal year
• Current Aging
Inventory:
• Current Listing/Valuation
Other Collateral Offered:
• Type
• Valuation
Page 3 of 3