Company Legal Name:
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Federal Tax ID:
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DBA:
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URL/Website:
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Business Location:
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City:
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State:
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Zip Code:
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Business Telephone:
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Own
Rent |
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Business Fax:
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Sq Footage:
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Mailing Address:
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City:
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State:
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Zip Code:
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Primary Contact:
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Title:
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Email:
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Decision Maker:
Yes
No |
Direct Telephone:
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Cell Phone:
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Company Information: |
What does the company do? (Describe The Products And/Or Services
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How will you Grow?
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Year Business Established:
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Current Owners:
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# of employees: |
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Full Time: |
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Part time: |
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Entity Type:
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Industry:
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Other Locations:
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How are the products sold?
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Is the business subject to a regulatory agency?
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Did you have any government or international sales?
Are sales seasonal?
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Management/Ownership Information |
Name of Bank:
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Satisfaction:
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Current Outstanding Loans:
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Deposit Needs:
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Branch Location:
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What could your bank be doing for you?
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What's important in your banking relationship?
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Credit Request
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General Information |
Do any of the owners listed on this application have an ownership, interest or continual liability in another company?
If yes, please provide owners name:
Company:
Ownership %:
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Has the borrower used or done business under any other names? |
Yes
No |
Does the borrower hold any assets to user? |
Yes
No |
Has the borrower, co-borrower, owner or guarantor ever been convicted of a felony? |
Yes
No |
Is the business an endorser, guarantor, or co-maker for obligations not listed on its financial statements? |
Yes
No |
Is the business a party to any claim or lawsuit? |
Yes
No |
Has the business ever declared bankruptcy? |
Yes
No |
Does the business use hazardous substance in the normal course of business? |
Yes
No |
Are any owners a Non-US. Citizen?
If yes, please provide name and indicate Residency Status:
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Yes
No |
Is the applicant, or any officer, Principal or Partner of the applicant currently on the Board of Directors of a Bank, Thrift or S&L? |
Yes
No |
Please name the business CPA:
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Tel:
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May we contact the CPA?
Yes
No |
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Please name your personal CPA:
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Tel:
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May we contact the CPA?
Yes
No |
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Signatures |
The signer(s) certify that the above statement and attached supporting schedules, including all financial statements and tax returns, prepared by or for the undersigned are a complete and true statement of the financial condition of the undersigned on the dated indicated. The signer(s) authorizes
Farmers State Bank to obtain consumer and/or business reports in their names as individuals at any time and to verify all portions of this financial statement, including all financial statements and federal tax returns, with appropriate sources.
Farmers State Bank is also authorized to provide credit information about the signer(s) to other creditors and credit reporting agencies. The signer(s) also agree to provide and further information the bank may require to process this application.
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