Commercial Loan Application

Required Fields

Business Information

Company Legal Name Doing Business As Federal Tax ID

Business Type

Sole Proprietor
Corporation
Partnership
LLC
Non-Profit
Other

Street Address City State Zip Code Mailing address is different than street address. Mailing Address City State Zip Code

Designated Company Contact (DCC) Information

Is the DCC a decision maker?

First Name Last Name Business Phone Number Business Fax Number E-mail Address Please do NOT email me important news and updates.

Business Details

Date of Establishment

Industry

Agricultural
Retail
Business
Wholesale
Manufacturing
Professional Services
Other

Describe the products and/or services this company provides.

Management/Ownership Information

Owner

Owner First Name Owner Last Name Owner Title Ownership Percentage Years of Industry Experience

Is this person a decision maker?

Is this person actively involved?

 Add Another Owner

Banking Information

Name of Bank Branch Address City State Zip Code

Rate your satisfaction.

High
Average
Low

Outstanding Loans

Loan

Loan Type Outstanding Amount

 Add Another Outstanding Loan

Credit Request

Credit

Credit Type Amount Collateral Use of Funds

 Add Another Credit Request

General Information

May we contact the CPA

Personal CPA Full Name Phone Number

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Farmers State Bank to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Farmers State Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date
Verify your not a robot