Commercial Loan Request Form - First National Bank of Pandora

Required Fields

Business Information

Company Legal Name Doing Business As Federal Tax ID Website URL

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 Preferred Contact Method 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. What are your projected sales this year?

Management/Ownership Information (Please note all owners with 25% or more ownership)

Owner

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

Is this person a decision maker?

 Add Another Owner

Credit Request

Credit

Credit Type Amount Collateral Use of Funds

 Add Another Credit Request Additional Comments

Endorsement

I certify that everything I have stated in this form is correct. You may keep this form whether or not I complete a loan application.

By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update this credit information at your request and if my financial condition changes.

Applicant's Signature Date

E-Sign Act Disclosure and Consent

Before proceeding you must confirm that you have read and agree to the terms of the Electronic Signature Act Disclosure available at the link below.

E-Sign Act Disclosure and Consent

I/we confirm that I have read and agree to the terms of the E-SIGN Act Disclosure above. I also agree that the Internet access device(s) I/we will use to receive the related legal disclosures, agreements, online account signature form and the instructions meet(s) the system requirements described in the disclosure presented above; and I/we consent to receiving the related legal disclosures, agreements, online account signature form and the instructions electronically.