Commercial Loan Application

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Company Legal Name:
 Federal Tax ID:
DBA:
 URL/Website:
    
Business Location:
 City:
 State:
 Zip Code:
  Business Telephone:
 Own Rent  
Business Fax:
 Sq Footage:
  
Mailing Address:
 City:
 State:
 Zip Code:
Primary Contact:
 Title:
 Email:
  
Decision Maker: Yes No Direct Telephone:
 Cell Phone:
  

Company Information:
What does the company do? (Describe The Products And/Or Services
 How will you Grow?
Acquisition/Merger
General Econ Growth
New Employees
New Market
New Product Line
Other

Year Business Established:

Current Owners:
# of employees:		    
Full Time:    
Part time:    

Entity Type:
Non-Profit LLC
Sole Proprietorship C-Corporation
General Partnership S Corporation
Limited Partnership  
   

Industry:
Agricultural Retail
Business Wholesale
Manufacturing Other
Professional Services  

Other Locations:

How are the products sold?
Direct Mail
Inside Sales Force
Manufacturer Rep/Distributor
Outside Sales Force
Telemarketing
Other:

Is the business subject to a regulatory agency?
No
Yes

Did you have any government or international sales?
No  
Yes   
Are sales seasonal?
No  
Yes    

Have you been profitable for the past 3 years? Yes No
What is the status of the industry? How many customers do you have?
How are you trending this year? Who are your top three customers?
What are you doing to increase sales? Who buys your products or services?
Projected Sales this year $ Why do your customers buy from you?
What payment terms do you offer your customers? Any foreign customers? (If so, what % of sales?)
What % of sales do your top 3 customers represent? Who is your competition?
How do you track your industry? How do you compete against them?

Management/Ownership Information
Owner:
 Title:
Ownership:

%		 Decision Maker: Yes No Industry Experience: yrs
Actively Involved: Yes No
Owner:
Title:
Ownership:

%		 Decision Maker: Yes No Industry Experience: yrs
Actively Involved: Yes No
Owner:
Title:
 Ownership:

%		 Decision Maker: Yes No Industry Experience: yrs
Actively Involved: Yes No
Owner:
Title:
Ownership:

%		 Decision Maker: Yes No Industry Experience: yrs
Actively Involved: Yes No
Owner:
Title:
Ownership:

%		 Decision Maker: Yes No Industry Experience: yrs
Actively Involved: Yes No

Name of Bank:
Satisfaction:
High  
Avg.  
Low  

Current Outstanding Loans:
Line $
Loan $
Lease $
Real Estate $
Other

Deposit Needs:
Std Checking  
Analysis  
Sweep  
Money Market  
Branch Location:
What could your bank be doing for you?
 What's important in your banking relationship?

Credit Request

Credit Line Amount:
Collateral:
Use of Funds:
Term Loan Amount:
Collateral:
Use of Funds:
Eq. Lease Amount:
Collateral:
Use of Funds:
Real Estate Amount:
Collateral:
Use of Funds:
Other Amount:
Collateral:
Use of Funds:

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 %:

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: 		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:
Tel:
May we contact the CPA? Yes No  

Please name your personal CPA:
Tel:
May we contact the CPA? Yes No  

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.
Signer:
 Date:
 Signer:
 Date: