Contact Information:

* Title

Mr.

Mrs.

Ms.

* First Name

* Last Name

* Home Address 1

* Home Address 2

* City

* State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Other

* Zip

* Primary Phone

Work Home Mobile Other

Secondary Phone

Work Home Mobile Other

Fax

* Email Address

Business Information - Borrower

* Do You Currently Have An SBA Loan?

Yes

No

* Company Name

Business Address 1

Business Address 2

* City

* State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Other

Zip/Postal Code

Business Phone

* Total Number Of Owners 1 2 3 4 5 More than 5

* Years of Relevant Industry Experience 0 1 2 3 4 5 more than 5

* Years of Relevant Management 0 1 2 3 4 5 more than 5

* Property Use Leased Space Real Estate Owned & Occupied Rental Income Property

* Business Type ---------Hospitality------- Restaurant Bar Nightclub Hotel / Motel --------Automotive---------- Auto Repair Shop Car Wash Gas Station --------Real Estate--------- Multifamily Office Retail Industrial Single Tenant --------Other---------------- Assisted Living Facility Child Care Provider Funeral Home Manufacturing Medical Profession Professional Service Provider Recreation Facility Retailers Wholesale Distibutor Other

* Square Footage of Space

Owner(s) Information

*First Name

*Last Name

% Business
Owned

Is this person
a Homeowner?

Yes

US Citizen Or
Resident Alien?

Yes

Authorize a
Credit Report? 

Yes

First Name

Last Name

% Business
Owned

Is this person
a Homeowner?

Yes

US Citizen Or
Resident Alien?

Yes

Authorize a
Credit Report? 

Yes

First Name

Last Name

% Business
Owned

Is this person
a Homeowner?

Yes

US Citizen Or
Resident Alien?

Yes

Authorize a
Credit Report? 

Yes

Project Costs & Loan Amount

Please Provide Details About Financing Your Project

	$ Amount
Equity Contribution by Borrower
Owner Financing Provided by Seller (Leave blank if $0)
Total Loan Amount You Are Requesting

Total Project Cost Allocation (Please complete all that apply with $ amounts)

	$ Amount
Purchase Commercial Real Estate
Refinance Existing Commercial Mortgage Refinance Other Debt
Purchase A Business Or Buyout Existing Shareholder
Renovate Existing Property
Construct Commercial Real Estate
Working Capital
Purchase Machinery, Equipment, Furniture, Fixtures
Other

Please Provide Any Additional Information Regarding The Use Of Your Loan

Collateral For Loan Request

Type of Asset

	Asset Value $	Existing Debt $	State  Location
Commercial Real Estate
Residential Real Estate
Rental Income Property
Machinery And Equipment
Furniture And Fixtures

Please Provide Any Comments About Collateral

Cash Flow Analysis

* Is this a Start Up Business?

Yes

No

* Do you have a Business Plan?

Yes

No

* The Figures Entered Below Are

From Tax Returns (preferred)

Estimates

Please include financial information for the business you own or are purchasing.

	Most Current Year 2006	Prior Year (2005	2nd Prior Year 2004
Total Annual Revenue
Total Annual Net Income
Depreciation / Amortization
Interest
Rent

Please Provide Any Comments About Cash Flow

* Indicates Response Required