Alliance Bank - Vortex Financial



BUSINESS DOCUMENTS / INFORMATION

□ Loan Application

□ Business Federal Income Tax Returns for the last three (3) fiscal year ends

□ Interim Business Financial Statements dated within the last 90 days

□ Business Income and Expense Projections 12 Month Proforma with detailed assumptions

□ Business Debt Schedule (see enclosed form)

□ Signed IRS 4506 Form (see enclosed form)

□ Business Bank Statement for one (1) year

□ Business History and Description

□ Business Fixture, Furniture and Equipment Schedule (see enclosed form)

□ Business License, Seller’s Permit and Health Permit, if applicable

□ Business Organization Documents

( Corps - Articles of Incorporation, Bylaws & Statement of Domestic Stockholder

( Partnership - Partnership Agreement and Certification of Partnership (Limited Partnership)

( Limited Liability Company - Operating Agreement, Article of Organization and Statement of Information

( Trust – Trust Agreement and Trust Certification

( Fictitious Business Name Filing Statement

□ IRS Employer’s Identification Number

PERSONAL / INDIVIDUAL INFORMATION

□ Personal Financial Statements dated within last 90 days on all Borrowers/Guarantors (see enclosed form)

□ Borrowers/Guarantors Personal Federal Income Tax Returns for the last three (3) years

□ Signed IRS 4506 form (see enclosed form)

□ Resumes of All Borrowers, Guarantors, and all Key Management Personnel (see enclosed form)

□ Driver’s License and/or Permanent Alien Registration Card

□ Form G-845 INS Verification (Alien Reg. Card, Visa, etc.)

IF APPLICABLE

□ Real Estate and/or Business Insurance Policy

□ Lease Agreement on Business Premises and/or Borrower’s Tenants including EPC Lease

□ Landlord’s Consent

□ Certified Copy of Escrow Instructions and Purchase & Sale Agreement

□ Business Acquisition

( Seller’s Federal Income Tax Returns for the last three (3) fiscal year ends

( Seller’s Interim Business Financial Statements dated within the last 90 days

□ Seller Carry Note

□ Refinance - Copy of Promissory Note, Current Mortgage Statement and/or Loan Payment History

□ Construction – SBA form 601(see enclosed form), Contracts, Blueprints, Cost Breakdown, Permits & Builder’s Risk and Worker’s Compensation Insurance for General Contractor

□ Current Accounts Receivable & Accounts Payable Aging Schedule

□ Franchise Agreement, Franchise Offering Circular

□ Purchase Orders, Invoices or Estimates for Fixed Assets

□ Business Plan for Newly Established Businesses

□ Appraisal Report

□ Environmental Questionnaire Disclosure Statement ( see enclosed form )

□ Life Insurance Policy

□ Verification of Deposit

LOAN APPLICATION

PERSONAL INFORMATION

Name S.S.#

Home Tel Work Tel Cell Phone

Current Address City St Zip

Previous Address City St Zip

Spouse S.S.#

Home Tel Work Tel Cell Phone

BUSINESS INFORMATION

Business Name Tax I.D.#

Current Address City St Zip

Business Tel Business Fax E-Mail

Type of Business No. of Employee: Before Loan After Loan Affiliates

Business Structure: ( Sole Prop ( Corp ( LLC ( Partnership (General / Limited)

Management (Proprietor, partners, officers, directors and all holders of outstanding stock – 100% of ownership must be shown)

|NAME |TITLE |% OWNERSHIP |

| | | |

| | | |

| | | |

Affiliates (List below any business concern in which the Applicant Company or any of the individuals listed above have any ownership.)

|NAME |TITLE |% OWNERSHIP |

| | | |

| | | |

| | | |

| | | |

USE OF PROPOSED LOAN PROCEEDS

Real Estate Acquisition $

Building Improvement $

Leasehold Improvements $

Machinery/Equipment $

Furniture/Fixtures $

Working Capital $

Refinance $

Business Acquisition $

REQUESTED LOAN AMOUNT

$

SOURCE OF DOWNPAYMENT

Name of Bank

Balance as of $

(Please attach a copy of bank statement)

Prior Government Assistance (List any previous SBA or Federal Government Debt, including subsidized student loans and disaster loans)

|NAME OF AGENCY |ORIGINAL AMOUNT OF |DATE OF REQUEST |APPROVED OR DECLINED|BALANCE |CURRENT OR PAST DUE |

| |LOAN | | | | |

| | | | | | |

| | | | | | |

List All Real Estate Owned (Use attachment, if necessary.)

| |PROPERTY A |PROPERTY B |PROPERTY C |

|Type of Property | | | |

|Address | | | |

| | | | |

|Date Purchased | | | |

|Original Cost | | | |

|Present Market Value | | | |

|Name & Address of Mortgage Holder | | | |

|Account Number | | | |

|Mortgage Balance | | | |

|Monthly Payment Amount | | | |

|Status of Mortgage | | | |

CITIZEN STATUS

( US Citizen ( Legal Permanent Resident ( Visa (Type, L1, L2, E1, E2)

Alien Reg. # Other

( Have you or any officer of your company ever been involved in bankruptcy or insolvency proceedings? (Yes ( No

( Are you or your business involved in any pending lawsuits? ( Yes ( No

( Are there any outstanding tax liens or judgements filed against your or your company? ( Yes ( No

( Does any applicant or their spouse or any member of their household, or any one who owns, manages or directs your business or their spouses or members of their household work for the Small Business Administration, Small Business Advisory Council, SCORE or ACE, a Federal Agency, or the participating lender? ( Yes ( No

If any of answers above is YES, please provide details.

By signing below you certify that the information you have given with this application is true and complete. You authorize us to verify your statements with any source and obtain credit and employment history (including your spouse’s if you live in a community property state).

By:

Date

By: Date

List of Fixture, Furniture and Equipment

Of _______________________________________________________

(This Schedule should contain all significant equipment above $500 only)

| |Description |Qty |Book Value |Serial No. |

|1 | | | | |

|2 | | | | |

|3 | | | | |

|4 | | | | |

|5 | | | | |

|6 | | | | |

|7 | | | | |

|8 | | | | |

|9 | | | | |

|10 | | | | |

|11 | | | | |

|12 | | | | |

|13 | | | | |

|14 | | | | |

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|17 | | | | |

|18 | | | | |

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|20 | | | | |

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Certificate of Secretary

(This applies to Corporations only)

I certify that I am the secretary of and that the

following persons hold positions in this corporation and/or own share in this corporation in the

amount and form designated.

1. Directors

Name:

Name:

Name:

2. Officers

President Name:

Vice President Name:

Secretary Name:

Treasurer Name:

3. Shareholders

Number of % of shares

Name Shares Outstanding

By: Date:

Secretary

| | |

|TRUST INFORMATION FORM | |

|(to be completed by Applicant) | |

1. Complete Name and Date of the Trust:

_________________________________________________________________________________

2. Is the Trust Agreement signed and notarized? Yes No

3. Trust’s tax identification number is: ______________________________________________

4. a) The names of the Trust Settlors are:

________________________________ ____________________________________

________________________________ ____________________________________

b) The names of the currently acting Trustees are:

________________________________ ____________________________________

________________________________ ____________________________________

c) The Trust expressly authorizes the Trustee(s) to engage in the following transactions: (check all applicable boxes)

Borrow monies and incur debts on behalf of the Trust and to hypothecate, encumber or pledge assets of the Trust for any debt of the Trust.

Guarantee the obligations of third parties and to hypothecate, encumber or pledge assets of the Trust

Establish bank accounts on behalf of the Trust, including the power to deposit into any account established in the name of Trust all monies collected and received on behalf of the Trust; to withdraw funds from said account; and, to issue checks or drafts upon said accounts.

d) The Trust is (please check one box): irrevocable; or, the Trust is revocable and the names of the persons holding the power to revoke the trust are: _____________________

e) The Trust instrument requires the signature of any __________ Trustee(s) to exercise any powers of the Trustee.

f) Title to Trust assets are to be taken in the name of:

_______________________________ _____________________________

Signature of Trustee Signature of Trustee

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SBA LOAN APPLICATION CHECKLIST

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