Small Business Loan Application - TD

Small Business Loan Application

Officer Name: Store #:

Store Name:

Officer #:

Phone #:

Sourced by: Store RM Healthcare Specialist Outbound Calling Team Biz2Credit

To be completed by Borrower(s)

Purpose

The following information is needed to better understand the lending needs for your business.

Select all that apply.

General or Capital Expenditures Business Improvements

Start up

Refinance or Debt Consolidation

Working Capital (specify use): ________________________________________

Other ____________________________________________________________

Purchase an Existing Business

Purchase Price: $_____________________

Purchase of Real Estate

Down Payment: $____________________

Purchase Vehicle (please describe): _____________________________________

Purchase Equipment (please describe): __________________________________

Modification to an Existing TD Bank Loan (excluding interest rate & fee changes) Existing TD Bank loan #:______________________________________________ Change Requested (please describe):_______________________________________________________________________________________________________________

New Increase Renewal

Product

Tell us which loan product(s) will help you meet your business needs.

SBA Express Agency Enhancement (available on Commercial Real Estate Mortgage, Term Loan, or Line of Credit)

Product

Amount Requested

Commercial Real Estate Mortgage $___________________

Fixed Rate (3 or 5 yrs) ____________ years

Amoritization (10 or 20 yrs) ____________ years

Term Loan

Term (up to 5 yrs) ____________ years $___________________

Express Lease

Term (up to 7 yrs) ____________ years $___________________

Time Note (up to 90 days)

$___________________

Product

Amount Requested

Line of Credit Letter of Credit ACH limit requested

Healthcare Products

$___________________ $___________________ Debit $___________________ Credit $___________________

Practice Financing Term (up to 10 yrs) ____________ years $___________________

Automatic Payment Deduction

Automatic Payment Deduction Payments are automatically deducted from your small business checking account.

TD Business Checking Account# ___________________________________________________________

Business Legal Name

Business Information (Applicant/Borrower)

The following information is required to process your loan request(s). Please complete all sections.

Doing Business as (DBA) Name, if any:

Primary Contact:

Tax I.D. #:

Telephone #:

Email Address:

Street Address (no P.O. Boxes):

Own Rent City:

State:

Zip Code:

Mailing Address (if different):

City:

State:

Zip Code:

C Corporation Sole Proprietor

S Corporation Limited Partnership

Limited Liability Company (LLC) General Partnership

Business Individual LLP

Non-Profit Other__________________________

Date Business Established: Month_______ Year_______

State of Incorporation:_________________ Number of Employees After Financing: ________________________

Explain Nature of Business: _______________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________

Manufacturing Wholesale Retail Service Agricultural Construction Other______________________________________________________ List any Affiliated Companies: ____________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________

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Collateral to Secure your Small Business Loan

The following information will help us better understand the assets being pledged to secure your business loan request(s).

CHECK ONLY the following collateral that is being offered to secure your Small Business loan request(s). Current Value, Lien(s), description & owner name(s) are required for all pledged collateral.

Collateral

TD Bank CD Savings

Current Value $___________________

Current Lien(s)

Describe Collateral (If real estate also provide address)

Owner Name(s)

Marketable Securities

Equipment New Used Vehicle New Used

$___________________ $___________________ $___________________

Accounts Receivable

$___________________

Inventory

Owner Occupied Real Estate Residential Commercial

Investment Real Estate Residential Commercial Mixed Use Other

$___________________ $___________________

$___________________

Business Obligations/Deposit Relationships

The following information is required to process your application & will help us get a complete view of your current banking relationships.

Include all business loans & business deposit relationships (including existing accounts with TD Bank). Do not include rent on office space or other facilities. (Attach additional sheets if necessary.) *Please indicate in the first column below which business obligations are being refinanced with this application and which business deposits will be coming to TD with this loan.

Business Obligations

Business Deposit Relationships

* Creditor Loan Type Current Balance Monthly Payment

$

$

Collateral

* Deposit Type

CHK SAV

Bank Name

Current Balance $

$

$

CHK SAV

$

$

$

CHK SAV

$

$

$

CHK SAV

$

Business Financials

The following information provides us details about the financial background of your business.

Business Financials (Applicant/Borrower) Balance Sheet as of: ____/_____/_____

Income as reported on most recent tax return fiscal year ending: _____/_____/_____

Cash

$

Accounts Payable $

GROSS SALES/REVENUE

$

(+)

Accounts Receivable $

Notes Payable

$

Cost of Goods Sold

$

(-)

Inventory

$

Credit Card Debt $

Owner's Salary

$

(-)

Machinery/Equipment $

Automotive Loans $

Interest Expense

$

(-)

Automobiles

$

Mortgages

$

Depreciation

$

(-)

Real Estate

$

Other

$

Remaining Expense

$

(-)

Other

$

BUSINESS NET INCOME / (NET LOSS) $

(=)

Declarations

The following questions are required to process your Small Business loan request.

Please provide details on an additional page to any question with a YES response.

Yes No 1. Is the applicant party to any lawsuit or subject to outstanding judgments?

Yes No 2. Is the applicant party to taxes or credit obligations past due? Amount: $____________________ Payable to: __________________________________________________________________________________________

Yes No 3. Has the applicant ever filed personal bankruptcy or served as an officer in a company that declared bankruptcy?

Yes No 4. Is the applicant presently under indictment or probation or parole, or ever been charged or convicted for any criminal offense other than a minor motor vehicle violation?

Yes No 5. Is the applicant a political party, a campaign, a candidate, a public official or foreign political official or an immediate family member of

such an official, or a business entity formed by or for the benefit of any public official?

If yes, name, relationship, & position of official: ________________________________________________________________________________________

Yes No 6. Is the applicant or any owner an employee of TD Bank, N.A. or one of its affiliates?

If yes, name of employee: __________________________________________________________________________________________________________

Yes N o 7. Is the applicant engaged in Internet Gambling? If yes, what type of Internet Gambling does the applicant participate in? _______________________________________________________________

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Credit Application Checklist

Bank Employee must initial next to each line item to validate that they have supplied the required documentation. If any items are omitted reasons why must be included.

Bank Employee

initials

__

__

__

Required Documentation Small Business Loan Application ? Completed, signed & dated. Attached sheet providing details to Declaration questions answered YES on page 2. Copy of Purchase & Sales Agreement/Bill of Sale, if applicable.

Reason for Omission

__

For investment real estate transactions, a schedule of all property owned showing year purchased,

purchase price, outstanding loans & payments, & gross rents & expenses.

__

For all applicants except non-profits a Personal Financial Statement must be completed.

Bank Employee

initials

__

__

__

__

__ __

__

Required Financial Documentation

One (1) year current business federal tax return (complete with all schedules) or Accountant prepared Financial Statement for the borrower and all entity guarantor(s).

One (1) year personal federal tax return - Complete with all schedules for each personal guarantor.

Interim YTD business financial statement (balance sheet & income statement) if the application date is more than (six) 6 months beyond fiscal year end.

Two (2) year current business federal tax return (complete with all schedules) or Accountant prepared Financial Statement for the borrower and all entity guarantor(s).

Accounts Receivable aging report if loan is for working capital purposes or secured by accounts receivable.

Two (2) year personal federal tax return - Complete with all schedules for each personal guarantor.

Three (3) year current business federal tax return (complete with all schedules) or Accountant prepared Financial Statement for the borrower and all entity guarantor(s).

$50,000.01? $100,000.01?

Over

$100,000

$250,000 $250,000

X

X

X

X

X

X

X

X

X

X

Reasons for Omission

Overdraft Protection

No Yes Would you like to apply for Overdraft Protection for your TD Bank Business Checking account? If yes, please provide your TD Bank Business Checking account #: __________________________________________________________________________________________.

If your request for overdraft protection is approved you may enter into the Bank's Small Business Overdraft Protection Agreement.

Representation

The undersigned certifies, acknowledges and agrees that: (i) each Applicant intends to apply for credit in the manner indicated in this application, (ii) all information provided in this application and in any attachment and supporting documentation is true and correct, (iii) each Applicant's intent is to apply for business purpose credit and such credit will not be used for personal, family, or household purposes, (iv) submission of this this application does not create a commitment to lend, (v) each Applicant and any guarantor may be required to submit additional information to process this request for credit, (vi) each Applicant and the undersigned hereby authorize the Lender and any of its agents to obtain and use any credit reports (including consumer credit reports on any individual who is an Applicant or proposed guarantor) and and/or to make employment or investigation inquiries deemed appropriate by the Lender in connection with this application and to exchange credit information in connection with this application and any update, renewal, account review, or extension, (vii) each Applicant and the undersigned hereby authorize and request Lender to share the information provided on this application, and the results of any investigation of the credit and financial condition of each Applicant and any proposed guarantor with the U.S. Small Business Administration and/or TD Equipment Finance ("TDEF") in order to allow Lender and TDEF to suggest a variety of credit products, and (viii) each Applicant and the undersigned hereby acknowledge receipt of a copy of the Customer Disclosure Page.

Name of Business (please print)

___________________________________________________________________________________________________________________________________________________________

Name of Authorized Signer (please print)

Authorized Signature

___________________________________________________________________

X______________________________________________________ Date_______/_______/_______

Bank deposits FDIC insured. | TD Bank, N.A. | Equal Housing Lender

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16214-SB (12/15)

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Customer Disclosure Page

Below are the disclosures that have been provided to you in a format in which you can retain for your records.

Right to a Copy of Appraisal

We may order an appraisal to determine the property's value and charge you for this appraisal. In the event the property is a 1 to 4 family residential property, we will promptly give you a copy of any such appraisal, even if your loan does not close.

Representation

The undersigned certifies that I intend to apply for Credit in the manner indicated in this application and certify that everything stated in this application and on any attachment is correct. The Lender may keep this application whether or not it is approved. I certify that the credit being applied for will be used for business purposes. My signature also certifies that the information on this application and all supporting documents is true, that my intent is to apply for business purpose credit in which the use of the proceeds will not be used to secure a dwelling or for home improvements, and that I am aware that this application is not a commitment to lend. Applicant may be required to submit additional information to process this request for credit. My signature authorizes and requests Lender to share the information provided on this application, together with the results of this investigation of the credit and financial condition of the company and each applicant, with the U.S. Small Business Administration ("SBA") and/or TD Equipment Finance Inc. ("Lessor") in order to allow Lender and Lessor to offer the credit product best suited to the company and each of the owner's/guarantor's financing needs.

Fair Credit Reporting Act (FCRA)

The owner/guarantor signing above hereby authorize the Lender, and any of its duly authorized agents, to obtain and use my credit reports and to exchange credit information in connection with this business loan application and any update, renewal, account review, or extension the Lender may require. Additionally, I hereby authorize the Lender to obtain my personal credit report(s), and/or to make employment or investigation inquiries deemed necessary by the Lender in connection with this business loan application. I have a right to ask if a consumer credit report was requested, and if a report was requested, and if I ask, I will be informed of the name and address of the consumer reporting agency that furnished the report. I understand and agree that the Bank can furnish information concerning my personal or business accounts to consumer reporting agencies and others who may properly receive that information. It is understood that a photocopy or fax of this form will also serve as authorization. I understand that I must update this credit information at the Lender's request and/or if my financial condition changes. The individual signing above authorizes and requests Lender to share the information provided on this application, together with (i) the results of its investigation of the credit and financial condition of the company and each applicant and (ii) consumer credit reports on each owner/guarantor, with the U.S. Small Business Administration ("SBA") and/or TD Equipment Finance Inc. ("Lessor") in order to allow Lender and Lessor to offer the credit product best suited to the company and each owner's/ guarantor's financing needs.

Patriot Act Authorization

Lender complies with section 326 of the USA Patriot Act. Lender may also ask to see your driver's license or any other photo identifying documentation. This law mandates that Lender verify certain information about you, including your name, legal address, date of birth, and Social Security or tax identification number, while processing your account application.

| Equal Housing Lender

62-16214-SB (12/15)

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