Generic Application Form Example

 

GENERIC: APPLICATION FORM

 

CONTACT INFORMATION
Contact Person:  
Street Address:  
City / Town / Postal Code  
Phone:  
Cell:  
Fax:  
Email Address:  
Skype:  

 

BORROWER’S LOAN REQUEST
Purpose  of Loan:  
Loan Term (Desired):  
Interest Rate (Desired):  
Interest Reserves:  
Total Project Cost:  
Principal Cash Contributions:  
Principal – Other Collateral:  
Total Soft Costs Expended to Date:

Loan Amount Requested:  
Completed Value:

Loan to Value Ratio:  
Lender Origination:  
Referring Broker Fees:  

 

PRINCIPAL OWNERS (must account for 100% of the ownership of the business)

 

List below all officers, directors, partners, owners, co-owners, and stockholders.

 

Full Legal Name Title % Owned Active in Company?
       
       
       
       
       

 

PROPOSED BORROWER INFORMATION
Company Name  
Type of Entity  
Tax ID Number  
Prior Project Experience  
Street Address  
City / Town / Postal Code  
County  
Web Site  
Place of Incorporation  
Date of Incorporation  
Country  
Number of Employees:  

 

BORROWER PRINCIPAL(S) INFORMATION
Principal (1)
Name  
Company Name  
Occupation  
Adjusted Gross Income 2010  
Adjusted Gross Income 2011  
Adjusted Gross Income 2012  
Total Assets  
Liquidity  
Real Estate Holdings  
Net Worth  
SS Number  
DL Number & State  
Credit Score  
Street Address  
City / Town / Postal Code  
Phone  
Email  
Principal (2)
Name  
Company Name  
Occupation  
Adjusted Gross Income 2010  
Adjusted Gross Income 2011  
Adjusted Gross Income 2012  
Total Assets  
Liquidity  
Real Estate Holdings  
Net Worth  
SS Number  
DL Number & State  
Credit Score  
Street Address  
City / Town / Postal Code  
Phone  
Email  
Principal (3)
Name  
Company Name  
Occupation  
Adjusted Gross Income 2010  
Adjusted Gross Income 2011  
Adjusted Gross Income 2012  
Total Assets  
Liquidity  
Real Estate Holdings  
Net Worth  
SS Number  
DL Number & State  
Credit Score  
Street Address  
City / Town / Postal Code  
Phone  
Email  
Principal (4)
Name  
Company Name  
Occupation  
Adjusted Gross Income 2010  
Adjusted Gross Income 2011  
Adjusted Gross Income 2012  
Total Assets  
Liquidity  
Real Estate Holdings  
Net Worth  
SS Number  
DL Number & State  
Credit Score  
Street Address  
City / Town / Postal Code  
Phone  
Email  

 

SOLICITORS / LAWYERS INFORMATION
Name  
Firm Name  
Firm Address  
City / Town / Postal Code  
Business Telephone Number  
Business Fax Number  
Cell Phone  
Solicitors Name  
E-mail Address  

 

ACCOUNTANTS INFORMATION
Name  
Firm Name  
Firm Address  
City / Town / Postal Code  
Business Telephone Number  
Business Fax Number  
Cell Phone  
Account Manager  
E-mail Address  

 

BANK INFORMATION
Name  
Bank Name  
Bank Address  
City / Town / Postal Code  
BIC / SWIFT Code  
Branch Code (if applicable)  
IBAN  
Officer / Account Manager  
E-mail Address  

 

EXECUTIVE SUMMARY (500 words)
 

 

 

 

 

 

 

EXIT / REPAYMENT STRATEGY (500 words)
 

 

 

 

 

 

 

REFERRING AGENT INFORMATION
Company Name:   Office:  
Contact Name:   Cell:  
Email Address:   Address: