Commercial Loan Inquiry

Required Fields

Business Information

Borrower Legal Name

Business Type

Sole Proprietor
Corporation
Partnership
LLC
Non-Profit
Other
Business Type

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

Designated Company Contact (DCC) Information

First Name Last Name Business Phone 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
Industry Description

Credit Request

Credit

Credit Type Amount Collateral Use of Funds

 Add Another Credit Request

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Mound City 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 Mound City Bank 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.

Applicant's Signature Date

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