Full Application Form

Loan Officer/Mortgage Broker

Are you a Mortgage Broker or working with one?

Yes No

Please select your Loan Officer/Mortgage Broker

Email Address

First Name

Last Name

Company Name

Phone Number

Are you a Loan Officer or working with one?

Yes No

Email Address

First Name

Last Name

Company Name

Phone Number

SBA Questions

Average Monthly Payroll of all employees?

Purpose of the loan:

Payroll Rent/Mortgage Interest
Utilities Other

Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction, or presently incarcerated, or on probation or parole?

Yes No

Detailed Explanation

Have you been arrested in the past six months for any criminal offense?

Yes No

Detailed Explanation

Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgement)?

Yes No

Detailed Explanation

Has an application for the loan you are applying for now ever been submitted to SBA or to a Certified Development Company or lender in connection with any SBA program?

Yes No

Detailed Explanation

Is the Applicant a franchise that is listed in the SBAs Franchise Directory?

Yes No

Detailed Explanation

Does the Small Business Applicant have any Affiliates?

Yes No

Detailed Explanation

Has the Small Business Applicant and/or its Affiliates ever filed for bankruptcy protection?

Yes No

Detailed Explanation

Is the Small Business Applicant and/or its Affiliates presently involved in any pending legal action?

Yes No

Detailed Explanation

Is the Applicant or any owner of the Applicant presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any bankruptcy?

Yes No

Detailed Explanation

If you are at least a 50% or more owner of the applicant business, are you more than 60 days delinquent on any obligation to pay child support arising under an administrative order, court order, repayment agreement between the holder and a custodial parent, or repayment agreement between the holder and a state agency providing child support enforcement services? .

Yes No

Detailed Explanation

Has the Small Business Applicant and/or its Affiliates ever obtained a direct or guaranteed loan from SBA or any other Federal agency or been a guarantor on such a loan?

Yes No

Is any of the financing currently delinquent?

Yes No

Detailed Explanation

Did any of this financing ever default and cause a loss to the Government?

Yes No

Detailed Explanation

Are any of the Small Business Applicants products and/or services exported or is there a plan to begin exporting as a result of this loan?

Yes No

Provide the estimated total export sales this loan will support:

Is the Small Business Applicant using (or intending to use) a packager, broker, accountant, lawyer, etc. to assist in (a) preparing the loan application or any related materials and/or (b) referring the loan to the lender?

Yes No

Are any of the Small Business Applicants revenues derived from gambling, loan packaging, or from the sale of products or services, or the presentation of any depiction, displays or live performances, of a prurient sexual nature?

Yes No

Detailed Explanation

No SBA employee, or the household member (see definition on page 1) of an SBA employee, is a sole proprietor, partner officer, director, or stockholder with a 10 percent or more interest, of the Applicant.

Yes No

Detailed Explanation

No former SBA employee, who has been separated from SBA for less than one year prior to the request for financial assistance, is an employee, owner, partner, attorney, agent, owner of stock, officer, director, creditor or debtor of the Applicant.

Yes No

Detailed Explanation

No member of Congress, or an appointed official or employee of the legislative or judicial branch of the Federal Government, is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or household member of such individual, of the Applicant.

Yes No

Detailed Explanation

No Government employee having a grade of at least GS-13 or higher is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant

Yes No

Detailed Explanation

No member or employee of a Small Business Advisory Council or a SCORE volunteer is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant.

Yes No

Detailed Explanation

Have you, or any business you controlled, ever filed for bankruptcy protection?

Yes No

Detailed Explanation

Is the United States the principal place of residence for all employees of the Applicant included in the Applicants payroll calculation above?

Yes No

Do any of your employees earn more than $100,000/year?

Yes No

If Yes, Did you calculate your estimated monthly payroll using the cap of 100,000 per employee?
Detailed Explanation

Has the Applicant, any owner of the Applicant, or any business owned or controlled by any of them, ever obtained a direct or guaranteed loan from SBA or any other Federal agency that is currently delinquent or has defaulted in the last 7 years and caused a loss to the government?

Yes No

Detailed Explanation

Are you, or any business you control, presently involved in any legal action (including divorce)?

Yes No

Detailed Explanation

Has the Business received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020?

Yes No

Loan Amount

Detailed Explanation

Is the Applicant or any owner of the Applicant Business an owner of any other business/affiliate, or have common management with, any other business/affiliate?

Yes No

Detailed Explanation

Schedule of Real Estate Owned and Sold

Property Address

Property City

Property State

Property Zip

Status

Ownership %

Type Of Property

Present Market Value

Balance of Mortgages & Liens

Gross Rental Income

Mortgage Payments

Insurance, Taxes, HOA (If Not Included in Payment)

Net Rental Income

Titled Under

Date Purchased

Purchase Price

Value of Improvements Made

Intended Occupancy

Are there any mortgages or liens?

Yes No

Creditor Name

Account Number

Loan Status

Monthly Payment

Unpaid Balance

Type

Credit Limit

Maturity Date

Is their another mortgage or lien?

Yes No

Creditor Name

Account Number

Loan Status

Monthly Payment

Unpaid Balance

Type

Credit Limit

Maturity Date

Add Additional Real Estate

Financial Accounts & Securities

Account Type

Name of Institution

Account Titled As

Account Number

Balance/Value

Description

Pledged (Held AS Collateral)

Yes No

Add Additional Account(s)

#	Document Name	File Type	Action

Foreclosure / Default Info

Yes No NA

Attorney Information

Trustee Information

Loan Workout Q & A

Yes No NA

1st Lien Current Mortgage Scenario

Monthly Payment Details

Total Monthly Payment

Rep Name & all other contact info....

Other Business/Affiliate Information

List 3 examples of past deals:

List 3 examples of past deals:

List 3 examples of past deals:

Type

Estimated Value ($)

Amount Owed ($)

Total:

$

$

Total Est. Value

- Total Amt Owed

= Total Net Worth

$

- $

= $

General Business Info

Location/Property Details

Business Details

Business Financials

Members/Officers (List all members with 20% ownership or more.)

Property Location

Property Characteristics

Property Details

Get Zillow Value

Property Access