Banking Loan Application Form

BANKING LOAN APPLICATION FORM

Applicant Information

Entity Type: Individual Sole proprietor Partnership Corporation LLC Trust

Date of Birth:    Phone:    Email:

Co-Applicant / Additional Borrower (if applicable)

Relationship to Applicant:    SSN:    DOB:

Loan Request

Requested Loan Amount: $    Desired Term (months):    Interest Rate (requested):

Repayment Frequency: Monthly Bi-weekly Weekly Balloon

Requested First Payment Date:    Requested Maturity Date:

Collateral / Security Offered

Estimated Collateral Value: $    Collateral Location/Address:

Employment and Income

Employer Address:

Position/Title:    Length of Employment (years):

Assets and Liabilities

Assets

Liabilities

Banking Relationships

Account Type: Checking Savings Business

Declarations and Certifications

By signing below, Applicant certifies that the foregoing statements and all attachments are true, complete and correct to the best of Applicant's knowledge. Applicant authorizes the bank and its agents to obtain credit reports and to verify any information provided in this application, including employment and income, from any source. Applicant consents to the disclosure of application information to third parties as required for credit investigation, loan servicing, insurance, and where otherwise permitted by law.

Applicant acknowledges that submission of this application does not constitute a commitment to lend. Applicant understands that any intentional misstatement or omission of material fact in this application may result in criminal or civil penalties and may constitute a basis for loan denial or future loan acceleration if discovered after funding.

Consent to Credit Inquiry: I authorize the bank to obtain consumer and/or commercial credit reports in connection with this application.

Bankruptcy/Past Due Accounts: Have you declared bankruptcy in the past seven years? Yes No    Are there any judgments, garnishments, liens, or pending suits against you? Yes No

Terms, Conditions and Applicant Acknowledgment

If credit is extended, the applicant agrees to the bank's standard loan documentation, security agreements, and any required notices. Interest rates, fees, repayment schedule, prepayment penalties and default provisions will be set forth in the loan contract and security instruments. Applicant understands that the bank may require additional information and documentation prior to loan approval.

Certification and Authorization

I certify under penalty of perjury that the information provided in this application and in supporting documents is true and correct. I authorize the bank to verify the information provided and to obtain reports necessary to evaluate creditworthiness. I agree to notify the bank promptly of any material changes to the information provided.

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