Loan Application Pack

LOAN APPLICATION PACK

Applicant Information

Individual Corporation LLC Partnership Other

Loan Request Details

Requested Loan Amount: $   Requested Term:

Income and Employment

References

Authorizations and Certifications

The Applicant certifies that the information contained in this application and any supporting documents is true, complete and correct. Applicant authorizes the Lender to obtain and use credit, employment and income verification, and to make other inquiries as necessary to evaluate this application. Applicant acknowledges that false statements may be grounds for denial or rescission of any loan commitment and may be punishable under applicable law.

Applicant hereby consents to the disclosure of credit and other financial information to affiliates, service providers and agents of the Lender for purposes of underwriting, servicing and collection.

WHEREAS

WHEREAS, Lender Name: is willing to consider extending credit to Borrower Name: subject to the terms and conditions set forth in this Loan Application Pack and any subsequent loan agreement;

WHEREAS, Borrower has applied for a loan for the purposes described above and represents that the proceeds will be used in accordance with the Purpose of Loan stated herein;

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained in this document, the parties agree as follows:

Scope of Work (Use of Loan)

The Borrower shall use the loan proceeds solely for the purposes described in this application. Any material deviation from the stated use must be approved in writing by the Lender prior to disbursement.

Payment Terms

Principal Amount: $   Interest Rate:

Late Fee: A late payment will incur a fee of of the past due amount or the maximum amount permitted by law, whichever is less.

Term and Termination

Effective Start Date:   Maturity / End Date:

Either party may terminate any commitment to advance funds upon written notice to the other party at least days prior to the effective termination date, except that obligations accrued prior to termination shall survive until fulfilled.

Confidentiality

Each party shall treat nonpublic financial and business information disclosed by the other party in connection with this application and any resulting loan as confidential and shall not disclose such information except to its employees, advisors or as required by law. This obligation does not apply to information that is publicly known through no breach of this agreement or independently developed by the receiving party.

Governing Law

This Loan Application Pack and any resultant loan documents shall be governed by and construed in accordance with the laws of the State of without regard to conflicts of law principles.

Entire Agreement

This document, together with any promissory note, security agreement, and other written documents executed in connection with the loan, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior understandings and agreements, whether oral or written. No amendment or waiver shall be effective unless in writing and executed by both parties.

Certifications

By signing below, the undersigned certifies under penalty of perjury that the information provided in this application is true and accurate, that the proceeds will be used as stated, and that the undersigned has authority to enter into this application and any subsequent loan documents on behalf of the named Applicant.

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