"*" indicates required fields Your Name* Company Name* Your Email* Company Web Address* Borrower Name* How Many Borrowers?Primary Contact*Contact Email Address* Primary Contact Phone Number*Primary Contact Relationship to Borrower: Borrower Mortgage Broker Realtor Other Loan Request Amount: Borrowing Purpose: Purchase Refinance Construction Renovation Includes: Real Estate Business Only If Purchase, is Site Under Contract? Yes No Physical Address of Property/Business Estimated value or purchase price of property to be mortgaged: Equity/Down Payment: (if applicable) Borrowing Entity: To Be Formed S-Corp C-Corp LLC Parnership Sole Proprietorship Trust Borrower/Guarantor Credit: Excellent Good Fair Poor What is your FICO score? FacilityWhen was building built? Square footage Square footage Square footage lot Parking spaces Building Type Auto Repair Tire Center Brake repair Muffler center Other Have there been underground store tanks on the property Yes No Is the property a former gas station Yes No Has there ever been any reported leaks or spills on the site? Yes Unknown Is oil stored on the site? Yes No Is this a Franchise? Yes No Name of Franchise Is this franchise Fran Data Certified Yes N/A (FranData is working with newer franchises and having a certification program that some lender’s are using in lieu of being on the franchise registry. These are new franchises that have signed a certification with FranData stating, among other things, they are eligible to obtain SBA funding)Are you on the SBA franchise registry? Yes No Unknown If a purchase, it this to finance the acquisition of an existing business? Yes No N/A If yes, are buyer and seller related? Yes No Has this business, any of its principals or affiliates previously requested government related financing? (SBA, USDA, VA, Student, etc?). Yes No If yes, explain Has this business, any of the principals / affiliates ever defaulted on any government loans resulting in a loss to the Government? Yes No If yes, explain Does this business, any of its principals or affiliates have any SBA Guaranteed loans outstanding? Yes No Name of Lender Loan Balance Is loan current? Yes No Are any owners, officers, directors or members of their immediate households serving as a federally elected official, employed by federal agencies GS-13 level or above, or serving in the military as a Major, Lieutenant Commander or higher? Yes 0 No 0 If “Yes”, please provide additional info regarding ok to get a government backed SBA loan. Yes No If “Yes”, please provide additional info regarding ok to get a government backed SBA loan. Are you a veteran of the US military? Yes No Branch Dates of Service Drivers License / State ID number Issue date Expiration date Current on federal state taxes for business or personal? Yes No If no, explain Are you obligated on any leases? Yes No If yes, explain Where is injection money coming from? Existing cash Existing cash Trust Stocks/bonds liquidation IRA liquidation 401k rollover Gift from family / friends Borrowed / HELOC From affiliate businesses Combination Will guarantor keep outside Yes No Personal Financial StatementAre any of the assets listed on this financial statement controlled by a Trust? Yes No Are there any of your assets, other than those indicated in the schedules, pledged in any way? Yes No If yes, explain Are any liabilities, other than those indicated in the schedules, secured, cosigned or guaranteed? Yes No If yes, explain
