FORGE Loan Application
P.O. Box 1138, Huntsville, AR 72740
479-738-1585 Phone
479-738-6288 Fax
carson@forgeonline.com
Please take your time filling out this application. If you need help, please
contact FORGE and a staff member will be available to help you.
All applicants must fill out pages 2 through 5. Small business applicants
requesting $20,000 or more must fill out pages 6 and 7 and/or send in a
business plan.
PAGE 1
PAGE 2
PAGE 3
PAGE 4
PAGE 5
PAGE 6
PAGE 7
COVER
CONTACT INFORMATION
COLLATERAL
PERSONAL FINANCIAL STATEMENT
PERSONAL FINANCIAL STATEMENT (detail)
DESCRIPTION OF BUSINESS
PRO FORMA BALANCE SHEET
ECOA Notice: The Federal Credit Opportunity Act prohibits creditors from
discriminating against credit applicants on the basis of race, color, religion,
national origin, sex, marital status, age (providing the applicant has the
capacity to enter into a binding contract); because all or part of the applicant’s
income is derived from any public assistance program, or because the applicant
has in good faith exercised any right under the Consumer Credit Protection Act.
The Federal agency that administers compliance with this law concerning this
creditor is the U.S. Small Business Administration, Washington, DC 20416.
Qualified individuals with disabilities are entitled to receive accommodations to
enable them to fully benefit from our programs and services. To make
arrangements, contact a FORGE staff member by calling 479-738-1585 or email
carson@forgeonline.com. The FORGE office is located at 204 Main Street in
Huntsville, Arkansas. The FORGE office is handicap accessible.
1
CONTACT INFORMATION:
Applicant’s Name:
DOB:
SS#:
/
/
County of Residence:
Address:
City:
State:
Home Phone:
Zip Code:
Cell Phone:
Place of Employment:
Work Phone:
Address of Employment:
Income:
Email Address:
Position:
How did you hear about FORGE?
Citizen
Yes
No
U.S. Resident
Yes
Race:
American Indian or Alaskan Native
Native Hawaiian or Pacific Islander
No Veteran:
Asian
White
Yes
No
Black or African American
Hispanic
Non-Hispanic
If the farm or business is an existing business list income for previous year: $
(Please include form 1040, Schedule F and/or Schedule C)
Co-Applicant’s Name:
DOB:
SS#:
/
/
County of Residence:
Address:
City:
State:
Home Phone:
Zip Code:
Cell Phone:
Place of Employment:
Work Phone:
Address of Employment:
Income:
Email Address:
Position:
How did you hear about FORGE?
Citizen:
Yes
No
U.S. Resident
Race:
American Indian or Alaskan Native
Native Hawaiian or Pacific Islander
Yes
No
Veteran:
Asian
White
Yes
No
Black of African American
Hispanic
Non-Hispanic
Name of nearest relative not living with you:
Address:
Home Phone:
Work Phone:
2
Credit References:
Name:
Phone #:
Name:
Phone #:
COLLATERAL:
ALL FORGE LOANS ARE SECURED BY SOME FORM OF COLLATERAL. Acceptable collateral includes, but
is not limited to, liens on tools, equipment, inventory, livestock, mortgages on real property,
securities and qualified cosigners.
Applicants Name:
Loan Amount:
I pledge the following items as security against this FORGE loan:
ITEM
MODEL#/DESCRIPTION
VALUE
REAL PROPERTY: (IF USED AS COLLATERAL)
Address:
( attach a legal description)
Value: $
Mortgage Holder (if any):
Equity: $
Payment: $
Mortgage Balance $
OTHER:
Explain:
3
PERSONAL FINANCIAL STATEMENT:
NOTE: The personal financial statement is a legal document, deliberately misrepresenting your
financial position in order to obtain a loan is bank fraud.
ASSETS (what you own):
VALUE
Cash:
Savings:
Include CD’s, IRA’s, Etc.
Accounts Receivable:
What is owed to you by companies or individuals
Stocks and Bonds:
Current Value
Real Estate: HOME
Real Estate: FARM
Real Estate: OTHER
(see page 5)
(see page 5)
(see page 5)
Vehicle:
Describe:
Vehicle:
Describe:
Tools:
Describe:
Equipment:
Describe:
Personal Property:
Describe:
TOTAL ASSETS:
LIABILITIES (what you owe):
Accounts Payable:
Short term current debts: utilities, rent, tuition, etc.
Student Loans:
Monthly Payments, Total $
Vehicle Debt:
Monthly Payments, Total $
Mortgages:
Monthly Payments, Total $
Credit Cards:
Monthly Payments, Total $
Unpaid Taxes:
Monthly Payments, Total $
Other Debts:
Bank Loans, Installment Loans, Family, Friends, etc.
TOTAL LIABILITIES:
4
NET WORTH (Total Assets-Total Liabilities) $
Initial
PERSONAL FINANCIAL APPLICATIONS:
Applicant’s Name:
Do you have life insurance? Yes
No
Do you have medical / health insurance? Yes
Term or whole life? Amount $
No
Company
DESCRIPTION OF REAL PROPERTY:
Home: Appraised Value$
Mortgage Holder
Balance $
Mortgage Holder
Balance $
Mortgage Holder
Balance $
Address:
Farm: Appraised Value $
Address:
Other: Appraised Value $
Address:
Unpaid Taxes, Judgements, Tax liens, etc. Explain:
Income: Salary $
Business Income: $
Total Family Income: $
Real Estate Income: $
Other Income: $
Farm Income: $
Co-Signer Income: $
I authorize FORGE, Inc. to make inquiries as necessary to verify the accuracy of the statements made
to determine my credit worthiness. I certify the above are true and accurate as of the stated date(s).
These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I
understand that FALSE statements may result in forfeiture of benefits and possible prosecution by the
U.S. Attorney General (Reference 18 U.S. C. 1001).
Signature of Applicant:
Date:
Signature of Co-Applicant:
Date:
Witness (Name):
Date:
Date:
Address:
5
BUSINESS PLAN TEMPLATE
HOW MANY YEARS HAVE YOU BEEN IN BUSINESS?
VISION/MISSION STATEMENT AND GOALS: Describe what the business produces, who the products
are for and what your goals are
KEYS TO SUCCESS: What do you need or what must happen for you to succeed?
RESOURCES, FACILITIES AND EQUIPMENT: List the land, equipment, human and financial resources
LIST THE MANAGEMENT TEAM? What is their experience running this type of business?
DO YOU HAVE A MARKETING PLAN? Explain:
WHAT DID YOUR BUSINESS GROSS LAST YEAR?
6
WHAT DID YOUR BUSINESS NET LAST YEAR?
BUSINESS PLAN TEMPLATE
PROFORMA BALANCE SHEET
PROJECTIONS EXPENSE:
YEAR 1
YEAR 2
Costs of Goods Sold
Salaries
Payroll
Outside Sources
Supplies
Repairs and Maintenance
Advertising
Vehicle Expenses
Accounting, Legal
Rent
Phone, FAX, Internet
Utilities
Taxes
Depreciation
Other
Annual Loan Payments
TOTAL EXPENSES
GROSS PROFIT
NET PROFIT
(Gross Profit – Expenses)
WHAT ARE YOUR ANNUAL HOUSEHOLD EXPENSES? WHAT DOES IT COST YOU TO LIVE?
DO YOU HAVE ANY OTHER SOURCES OF INCOME? IF YES, EXPLAIN:
HOW MANY JOBS WILL YOUR BUSINESS CREATE? FULL TIME
HOW MANY JOBS WILL YOUR BUSINESS RETAIN? FULL TIME
PART TIME
PART TIME
OWNER NAME:
ADDRESS:
PHONE #:
BUSINESS EMAIL:
BUSINESS WEBSITE:
7
8