Business Loan Application

Business Information

Business Name Tax ID Number Business Phone Number Business Fax Number

Business Type Sole Proprietor Corporation Partnership LLC Non-Profit Other

Business Type What does the company do Street Address City State Zip Code Mailing address is different than street address.

Mailing Address City State Zip Code

Signer Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mailing Address City State Zip Code Daytime Phone Number Home Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted? Home Phone Work Phone Email Other

Other Preference

Products and Services Needed

Select additional services needed. Small Business Checking Online Banking Business Savings Certificate of Deposit Treasury Management

The purpose of this questionnaire is to begin the application process. All applications are subject to approval.

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Bank Name 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 Bank Name to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

You may transmit this application securely via the internet, but accounts will not be opened until the appropriate documents are signed or provided at any of our bank's locations.

Applicant's Signature Date