SBA Loan: Quick Start Assessment Powered by

SBA Loan: Quick Start Assessment

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SBA ASSESSMENT FORM

Personal Information

Full Name: ___________________________________________________________________

Address: _____________________________________________________________________

City: ______________________________ State: _______________ Zip: _____________

Home Phone: ___________________________ Cell Phone: _________________________

Work Phone: ___________________________ Home Fax: __________________________

Email: __________________________________________________

Are you a citizen of the USA? Yes No If no, do you have an alien registration card (green card)?

Yes No

Confidential Personal Information

What is your credit score? ____________ (If you don't have your credit score, you can get it at or )

Have you ever been convicted of any misdemeanor or felony? (Other than a minor traffic violation) Yes No

If yes, please explain:

Have you or a corporation owned or controlled by you ever been involved by a bankruptcy? Yes No If yes, please explain:

Are you currently involved in any lawsuits or legal actions, either as a plaintiff or defendant? Yes No If yes, please explain:

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SBA ASSESSMENT FORM

Education Level

Years of schooling: 1 - 12

13 - 16 Over 16

Degrees: High School

College

Grad/Post Grad

Last Degree Earned: ____________________________________________________________

Employment Information

Current Employer: _____________________________________________________________

Employed Since: ________________________ Will you remain employed? Yes No

Address: _____________________________________________________________________

City: ______________________________ State: ________________ Zip: _________________

Work Phone: _____________________________ Work Fax: ___________________________

Position: _________________________________ Annual Income: ______________________

Spouse's Employer: _____________________________________________________________

Employed Since: __________________________

Position: __________________________________ Annual Income: ______________________

Business Information

Will there be a co-borrower (spouse) or anyone owning more than 20% of the business?

Yes No

Have you identified a business you're interested in? Yes No

If yes, what is the name of the business? ___________________________________________

Is this a new or existing business? New Existing

What is your total project cost (if known)? __________________________________________

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SBA ASSESSMENT FORM

Assets and Liabilities

ASSETS Cash on hand & in Banks................................ Savings Accounts ............................................ IRA or Other Retirement Account ................ Accounts & Notes Receivable ....................... Life Insurance - Cash Surrender Value Only Stocks and Bonds ............................................ Real Estate ........................................................

(Describe in Section 3) Automobiles - Total Present Value Other Personal Property Other Assets

Total

(Omit Cents)

$ _________________ $ _________________ $ _________________ $ _________________ $ _________________ $ _________________ $ _________________

$ _________________ $ _________________ $ _________________

$ _________0________

LIABILITIES Accounts Payable.......................................... Notes Payable to Banks and Others..........

(Describe in Section 2) Installment Account (Auto)........................

Mo. Payments $ ______________ Installment Account (Other)......................

Mo. Payments $ ______________ Loan on Life Insurance................................. Mortgages on Real Estate...........................

(Describe in Section 3) Unpaid Taxes ................................................ Other Liabilities ............................................ Total Liabilities ............................................. Net Worth .....................................................

Total

(Omit Cents)

$ _________________ $ _________________

$ _________________

$ _________________

$ _________________ $ _________________

$ _________________ $ _________________ $ _________0________ $ _________0________ $ _________0________

Notes Payable

Section 2. Notes Payable to Banks and Others. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)

Name and Address of Noteholder(s) Original

Current Payment

Frequency

How Secured or Endorsed Type of

Balance

Balance

Amount (monthly, etc.)

Collateral

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SBA ASSESSMENT FORM

Real Estate

Section 3. Real Estate Owned

Type of Real Estate (e.g. Primary Residence, Other Residence, Rental Property, Land, etc.) Address

(List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part

of this statement and signed.)

Property A

Property B

Property C

Date Purchased Original Cost Present Market Value Name of Mortgage Holder Mortgage Balance Amount of Payment per Month/Year

Annual Income and Expenses

Annual Income

Applicant

Salary Dividend/Interest Income Rental Income Alimony/Child Support Other (detail):

TOTAL INCOME

$ 0

Joint Applicant

(spouse or co-borrower)

$ 0

Annual Expenditures

Rent/Mortgage Payment Property Taxes Utilities Insurance (home/auto) Alimony/Child Support Personal Expenses Income Taxes Other

TOTAL EXPENDITURES

Anticipated Annual Income from New Business (if known): ____________________________

Applicant

$ 0

Joint Applicant

(spouse or co-borrower)

$ 0

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