Application Questions:

1) Name:

2) Business Phone:

3) Residence Phone:

4) Residence Address:

5) Residence City, State, Zip:

6) Cash on Hand and in Banks: $

7) Savings Accounts: $

8) IRA or Other Retirement Account: $

9) Accounts & Notes Receivable: $

10) Total Life Insurance-Cash Surrender Value Only: $

11) If Life Insurance Has Surrender Value, what are face amounts of each policy, name of insurance company and beneficiaries:

12) Total Stocks and Bonds Value: $

13) List number of shares of each stock, or number of other type of security (example bond), its original cost, and its market value/quote as of a date that you indicate:

14) Total Value of Real Estate Owned: $

15) For each piece of real estate owned, list type of property, name of property owner, address of property, date purchased, original cost, present market value, name and address of mortgage holder, mortgage account number, mortgage balance, amount of payment per month and per year, status of mortgage, monthly rental income, monthly taxes and insurance:

16) Present value of automobiles owned: $

17) Total other personal property present value: $

18) Describe the personal property for which the total is given in #17:

19) Is any of the personal property in #18 pledged as security: (Yes/No)

20) If Yes is answer to #19, provide name and address of lien holder, amount of lien, terms of payment, and if delinquent describe delinquency:

21) Total value of other assets: $

22) Desribe assets included in #21:

23) Value of notes payable to banks or others: $

24) Describe the notes in #23 by providing the following information for each note: Name and Address of Noteholder, Original Balance, Current Balance, Payment Amount, Frequency (monthly, etc.), How the note is secured endorsed and the type of collateral involved:

25) Are there any car installment accounts: (Yes/No)

26) If Yes is answer to #25, what is the monthly payment: $

27) Total credit card debt: $

28) Total monthly payments on credit card debt: $

29) Are there any loans on life insurance: (Yes/No)

30) If Yes is answer to #29, what is the balance: $

31) Are there unpaid taxes: (Yes/No)

32) Amount of unpaid taxes: $

32) If Yes is answer to #31, describe in detail as to type, to whom the taxes are payable, when they are due, amount, and to what property, if any, a tax lien attaches:

33) Are there other liabilities: (Yes/No)

34) If Yes is answer to #32, describe the liabilities:

35) What is your salary: $

36) What is your net investment income: $

37) What is your real estate income: $

38) Is there other income: (Yes/No)

39) If Yes to #38, what is your other income: $

40) Describe the other income in #39:

41) Are you an Endorser or Co-Maker giving him any contingent liabilities (e.g., has he co-signed for anyone leasing a car): (Yes/No)

42) If Yes to #41, what is the balance of the contingent liability: $

43) Are there any legal claims or judgments: (Yes/No)

44) If Yes to #43, what is the balance of the contingent liability: $

45) Are there any provisions for Federal Income Tax: (Yes/No)

46) If Yes to #45, what is the balance of the contingent liability: $

47) Is there any other special debt: (Yes/No)

48) If Yes to #47, what is the balance of the contingent liability: $

49) Are any personal assets pledged other than described in #19: (Yes/No)

50) If Yes, to #49, provide an explanation:

51) Are any assets owned by a trust, is a copy of the trust agreement available: (Yes/No)

52) Has credit been obtained under other names or with other individuals? (Yes/No)

53) If Yes to #52, provide names and social security numbers:

54) Have you ever declared bankruptcy or had a judgment against him: (Yes/No)

55) If Yes to #54, explain:

56) Have you ever been a principal or guarantor of a firm that declared bankruptcy: (Yes/No)

57) If Yes to #56, explain:

58) Have you been a party to any claims or suits: (Yes/No)

59) If Yes, explain:

60) Have you been audited by the IRS in the last 3 years: (Yes/No)

61) If Yes to #60, has the tax return been finalized with all issues settled: (Yes/No)

62) If No to #60, explain:

63) Are you a director, executive officer or principal shareholder of an insured bank or financial institution that makes commercial loans and accepts deposits, or any bank or banking-related company, their subsidiaries or any company controlled by any of those entities: (Yes/No)

64) If Yes to #63, which company:

65) Are you leasing any real or personal property: (Yes/No)

66) If Yes to #65, explain:

67) Do you have any pending credit applications at other financial institutions: (Yes/No)

68) If Yes to #67, explain:

69) Have you ever been charged with, or convicted of, any criminal offense other than a misdemeanor involving a motor vehicle violation: (Yes/No)

70) Are you employed by the US government: (Yes/No)

71) If Yes to #70, give agency and position:

72) Are you a US Citizen: (Yes/No)

73) If No to #72, what is his Alien Registration Number:

74) Are you presently under indictment, on parole or probation: (Yes/No)

75) If Yes to #74, indicate date parole or probation is to expire:

76) Have you ever been convicted, placed on pretrial diversion or placed on any form of probation, including adjudication withheld pending probation, for any criminal offense other than minor vehicle violation: (Yes/No)

77) What is your place of birth:

78) What is your date of birth:

79) What day and month did you start living at your current residence:

80) If you have been at your current address less than 10 years, list your previous addresses and month and year that you started and stopped living at those address:

81) Are you married: (Yes/No)

82) If Yes to #81, what is your spouse's first, middle, last name, maiden name, and social security number:

83) List all of your schools, dates attended, majors, and degrees or certificates attained:

84) If you have had any military services background, what branch and what start and stop dates:

85) List your work experience chronologically beginning with present employment, stating present company's name and location, dates of employment, title and duties

These are the documents you will need to provide:

1) Personal 1040 Federal Tax Returns with all schedules for 3 years, complete for all owners, partners, officers, directors, guarantors, and stockholders with 20% or more of total stock owned

2) Business Federal Tax Returns with all schedules for 3 years, including affiliated business if applicable. If latest return is on extension, we will need a copy of the extension and the prior 3 years of tax returns.

3) Business Schedule of Debts (see Accounts Receivable/Payable clarification below). This schedule should include loans for contracts, notes leases payable and lines of credit. Example would include cars, trucks, equipment, furniture, and computers. It should not include accounts payable and or accrued liabilities.

4) The 85 questions above are require for anyone with 20% or more of total stock issued. Must be signed by spouse even if not involved in business, per SBA requirements.

5) Latest Business Financial Statements available (profit and loss with balance sheet, current, not older than 90 days from date of application)

6) Authorization to release information (email us for this form)

Business Schedule of Debts Clarification: Should include the following:

1) Accounts Receivable and Accounts Payable Aging Summary, broken down by aging (current - 30 days, 31-60 days, 61-90, over 90 days), $ amount for each of timespan, total $ A/R, total $ A/P, total number of accounts of A/R, and total number of accounts of A/P

2) for A/R representing more than 20%, the account name, outstanding balance

3) for A/R over 90 days old, account names, collectability probabilities, outstanding balances

4) for A/P over 90 days, account names, reason still not paid, unpaid balance

5) In the Business Debt Summary for each loan/lease: creditor name, original amount, original date, present balance, interest rate, maturity date, monthly payment, collateral/security