Commercial Loan Application

Thank you very much for considering Farmers State Bank of Waupaca. Farmers State Bank provides financing for start up, early stage, and growing businesses. The information we are requesting will help us better understand your business and enable us to determine the best loan structure for your particular needs.

If you have any questions, or are having difficulty in completing this form, please contact your loan officer at (715) 258-1400.

(If any questions do not apply to your business, please write NA. If any information is unknown at this time please write Unknown. Not all of this information must be known at the time of the application, but please do not leave any blanks.)

1. Borrower Information

Name of Borrower:
Name of Business: (If Different)
Social Security #:
Tax ID #:
Street Address:
City, State, Zip:
Mailing Address:
City, State, Zip:
Phone: Fax #: 
Cell Phone:
E-mail Address:
Current Lender:
Lender Contact: Phone:
Phone: Fax #: 
Form of Entity: C-Corp S-Corp Partnership Sole Owner
Number of Employees: Full-time Part-time

Management Ownership

Name Title Annual Compensation Ownership %
    (Must Total 100%)

For each individual above, please provide the following:

  • Personal Financial Statement, less than 60 days old
  • Personal Resume
  • Names of affiliates (companies which any of the above individuals have 20% or more ownership)

History of Business

Please submit a business plan, if available, or provide a description of your business which should include the following:

  1. Date business was established
  2. Date present owners gained control
  3. Types of products or services offered
  4. Market area and competition
  5. Trends affecting your industry
  6. Any other information you feel would help us better understand your business.

Financial Information

The financial data requested below is essential to the decision making process. Please provide the following information with your application:

  1. Year-end balance sheet and income statements for the company's three previous fiscal years.
  2. Interim balance sheet and income statement dated within 60 days of this application.
  3. Schedule of business debt listing debts as of the most recent balance sheet submitted.
  4. Projections for at least the next two years, including detailed assumptions.
  5. If you are a sole-proprietorship, you will need to provide three previous years of completed Federal tax returns.

2. Loan Request Amount

Loan Request Amount: $ Term of Loan: Years

3. Type of Business

Check all that apply: Industry:

4. Length of Time in Business

Start-up 1 - 5 years 5+ years

5. Use of Proceeds

New Construction/Expansion (1) $
Acquisition of Machinery and Equipment (2) $
Land and Building Acquisition (3) $
Additional Working Capital (4) $
Purchase Inventory $
Refinance Existing Debt $
Leasehold Improvements $
Other: Please Specify $
LESS: Owners Contribution
     (If not cash explain on a separate sheet)
(1) Construction Projects, please provide:
  • A breakdown of the estimated cost of the project
  • Preliminary plans and specifications
  • A signed construction contract, if available
(3) Real Estate Acquisitions, please provide:
  • A copy of the Offer to Purchase
  • Appraisal, if available
(2) Machinery and Equipment Acquisitions, please provide:
  • A detailed list of items to be acquired including cost per item
  • Make, model and serial numbers, if available
(4) Working Capital Requests, please provide:
  • A cash flow forecast which demonstrates the need for additional funds (worksheets are available)

Personal Resume

Name: Title:


Institution or Training Major   Dates Attended
From - To
Degree or Certificate

Work Experience

Company Title Dates Employed
From - To
Duties & Accomplishments
Other Business Related Interests or Activities:

Business Debt

Name of Business:
(Should be same as latest financial statement or tax return)

Include all debts except accounts payable and accrued expenses. The current balance and total must agree with the latest balance sheet submitted. **Please indicate with the below checkboxes those loans to be refinanced with the proposed request.

*Please indicate if the loan is current, delinquent, or paid-in-full.  Also list on this schedule, any debt incurred after the date referenced above.

Creditor Loan
Rate of
Collateral Payment
Total: $  


Estimated Projection and Forecast of Three Years' Earnings (Attach Assumptions Providing Explanation for Figures)

Gross Receipts $ $ $
Merchandise Cost $ $ $
Gross Profit $ $ $
Officer(s) Salaries (if any) $ $ $
Employee(s) Wages $ $ $
Advertising $ $ $
Rent $ $ $
Depreciation $ $ $
Supplies $ $ $
Electricity $ $ $
Telephone $ $ $
Interest $ $ $
Repairs $ $ $
Taxes $ $ $
Insurance $ $ $
Bad Debts $ $ $
Misc. *(postage, etc.) $ $ $
Total Expenses $ $ $
Net Profit Before Income Taxes $ $ $
Less Income Taxes $ $ $
Net Profit After Taxes $ $ $
Less Withdrawals (Proprietorship/Partnership) $ $ $
Net Profit $ $ $

*If sum is large, please itemize.

I certify the above data fairly represents the projected financial outlook to the best of my knowledge.

I certify that everything I have stated in this application and on any attachments is correct. The bank may keep this application whether or not is is approved. 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 credit information at your request if my financial condition changes.

(Name of Business):
Please fill out and submit a Personal Financial Statement for each individual who has 20% or more ownership interest in the business.