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Status:?Business?Address:?_________________________City:?__________________State:?____?Zip?Code:?________??????????????????[??]?Combination?of?both????????????????????????Annual?gross?business?sales?last?year?:?USD?_____________________________________________________????????????????? For?Office?Use?Only:????????????Loan?Application?????????Date:?□?Received??????__________?□?Entered?????????__________?□?Completed???__________?The?information?you?provide?in?this?application?will?be?held?strictly?confidential.?This?application?must?be?submitted?with?a?copy?of?your?State?issued?ID?and?your?recent?passport?photo.?I.???Borrower’s?Information?First?Name:?__________________Middle?Initial:?____ Last?Name:?_______________SS#:?_________________?Home?Address:?________________________?City:?__________________?State:?______?Zip?Code:?__________??Ward?or?County:?_____________________?Website?and/or?Facebook:?________________________________??Phone:?______________Cell:_____________E-mail:?_____________________?Birth?Date:?___/___/______??Marital?Status:??????????Single?????? Married????????? Divorced??????????Widowed????Gender?:????????Female??????????Male????????????Family?Size:?Adults:?______?Children:?______???II.?Employment?Status?Name?of?Employer:?_____________________________________Your?Position:______________________?Employer’s?Address:?____________________?City:?_________________State:?______Zip?Code:?________?Household?Annual?Income?Last?Year:?USD?$______________________________????????????????????????????????????????????????????????????III.?Business?Information?Business?Name:?______________________________?Date?Started:?____/___/_______??????????????????????????????Business?Owner:?_______?or?Partner:?______?If?partner,?provide?partner?(s)?information?on?a?separate?paper.??Employee?Identification?Number?(EIN):?_______________?Dun?&?Bradstreet?D-U-N-S?Number:____________?Average?time?spent?on?Business?:?____hrs/Week??Is?the?Business?Seasonal:?Yes/No,??Specify?Season:?_____???What?does?the?company?provides:??[??]?Products????????[???]?Services???????List?of?Products:?__________________________________________________________________________?List?of?Services:?___________________________________________________________________________?Total?net?profit?last?year?:?USD?_______________________________________________________________?How?many?people?did?you?hire/pay?the?last?12?months?(incl.?yourself,?part-time?&?temporary,?contractors,?friends):?_____and,?if?you?get?the?loan,?how?many?do?you?estimate?to?hire/pay?the?next?12?months:?____?IV.?Loan?Information?Do?you?have?a?bank?account?????????Yes???????? No?If?yes,??????? Personal???????????Business???????????Both?Type?of?account:??????? Checking??????? Savings????????? Both?Have?you?ever?received?a?loan?for?your?business?before???????? Yes??????No?What?is?the?Loan?amount?you?are?seeking?from?Life?Asset??$_____________________________________?Purpose?of?the?loan?(Check?all?that?apply):?????????? Working?Capital???????? Puchase?of?inventory???????????Purchase?of??Equipment????????? Refinance?Existing?Loan???????? Other,?Specify:?________________________???????????Total?Budget?for?the?project?(For?start-ups):?____________???Source?of?repayment:??????Business????????? Other:?________________________________________________?Monthly?payment?you?would?feel?confortable?with:?$?___________________________________________?V.???Socio?Economic?Information?How?did?you?hear?about?us??_______________________________________________________________?Country?of?origin:?_________________Years?living?in?the?US:?______?Primary?Language:?______________?Veteran?:??????? Yes??????? No???????Senior:?????Yes???????No?Desabled:?????Yes??????No????Ex-Offender:????? Yes??????No?Highest?Level?of?education?Completed:??????Your?Ethnicity:?Below?Primary?????????????????? Techinical????????????????????Latino????????????????????????????Asian?or?Pacific?Islander?Primary???????????????????????????????College/University???????????????????? African??Caribbean?High-School???????????????????????Graduate?School???????????????????????? African?American?Other_______________?VI.?Additional?Required?documents??a)??ID?Card?????????b)?Social?Security?Card??and????????c)?VOID?Check?Certification?The?undersigned?certifies?that,?to?the?best?of?his?or?her?knowledge?and?belief,?all?information?contained?in?this?loan?application?and?in?the?accompanying?statements?and?documents?is?true,?complete,?and?correct.??The?undersigned?agrees?to?notify?Life?Asset?immediately?of?any?material?changes?in?this?information.???I?understand?that?Life?Asset?may?pull?my?credit?score?or?credit?report?(will?not?effect?the?loan?approval?but??for?the?purpose??of?tracking?Credit?Score?progress).?Business?Name?(Print):?_________________________________________________________________?Applican?Signature:??____________________________________?Date:?_______?/____??/____________?Applicant?Title:?_______________________________________________________________________? ................
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