Loan Officer/Mortgage Broker
Yes No
Borrower Info

Yes No
Mailing Address


Personal Info
 Unmarried  Married  Separated
 U.S. Citizen  Perm Resident Alien  Non-Perm Resident Alien
Yes No
 Currently serving on active duty
 Currently Retired, discharged, or separated from service
 Non-activated member of the Reserve or National Guard
 Surviving Spouse
Borrower Background
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
SBA Questions
$

$
Payroll Rent/Mortgage Interest
Utilities Other
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
$
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

Schedule of Real Estate
Yes No
Yes No
Business Entity
Yes No
`

  General Business Info

 

  Location/Property Details


Urban Rural
$
$

  Business Details

Service Product
B2B B2C
Yes No
Yes   No
Yes No
Yes No
Yes No

  Business Financials

$
$
$
$

Members/Officers

(List all members with 20% ownership or more.)
Same as Borrower/Applicant Info Above
   
Name
Title
% of Ownership
%
Address
Phone
Cell
SSN
DOB
Email
Drivers License
Drivers License State
Add More Members/Officers Info
Subject Property Details

  Property Location

Urban   Rural

  Property Characteristics

  Property Details

In Month

  Property Access

Yes No
VENDOR & EQUIPMENT INFORMATION
 
Loan Terms
$
%
%
%
Yes No
 Current Loan Balance
 Total Loan Amount     
 Set Manual Payment
$ 0
Yes No
Yes No
Yes No
$
$

$


$
$
$

%

%

%

Insurance Company Info
Borrower Employment Information
I have ownership share of less than 25%
I have ownership share of 25% or more
Weekly   Monthly   Every 2 weeks   Twice a month


Borrower Monthly Income
$
$
$
$
$
$
$
$

$

(Borrower)
Borrower Monthly Expenses

Monthly Payment

Bal Owed

$
$
$
$
$
$
$
$
$
$
$

$

(Borrower)

Billing/Payment Information

Check:

Personal Checking
Personal Savings
Business Checking

Credit Card: