Business Loan Application Form

Step 1 of 5

20%

Application For:(Required)

Business Term Loan

Commercial Real Estate Loan

Business Line of Credit

Other

Amount Requested(Required)

Term Requested(Required)

Loan Purpose(Required)

Member Business Information

Legal Name of Member (Borrower)(Required)

First Middle Last

Legal Name of Business(Required)

Tax I.D. Number(Required)

Principal Place of Business (no P.O. Box)(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address (if different)

Street Address Address Line 2 City State ZIP Code

Primary Contact Name(Required)

First Last

Business Telephone(Required)

Business Fax

Date Business Established(Required)

# of years under current ownership(Required)

State of Registration(Required)

State

Annual Sales $(Required)

Describe Products/Services(Required)

Current Number of Employees(Required)

Type of Ownership (Select One)(Required)

General Partnership

Limited Partnership

Non Profit

Proprietorship

C-Corp.

S-Corp.

LLC

Professional Association

E-Mail Address(Required)

Does applicant have any open deposits or loan accounts with Credit Union?(Required)

Yes

Business Share Draft Account with Credit Union

Owner's Information

Owner Details

Full Legal Name	Percentage of Ownership	Title Currently Held	Actions

There are no Owners.

Maximum number of owners reached.

Current Accounts

Do you have any current loans?

Yes

Institution or Broker Disclosure

Name of Institution or Broker	Type of Account	Account Number	When Opened	Current Balance	Actions

There are no Entries.

Maximum number of entries reached.

Current Loans

Name of Lender	Rate	Collateral Description	Amount of Monthly Payment	Current Balance	Actions

There are no Entries.

Maximum number of entries reached.

Additional Information

Has applicant ever obtained credit under another name?(Required)

Yes

Is applicant liable for debts not shown, including any contingent liabilities such as leases, endorsements, guarantees, etc?(Required)

Yes

Has applicant ever declared bankruptcy or had any judgments, garnishments, repossessions, or other legal proceedings filed against them?(Required)

Yes

Is applicant currently a defendant in any suit or legal action?(Required)

Yes

Are there any tax obligations, including payroll or real estates past due?(Required)

Yes

Does any customer or supplier currently account for more than 20% of your business?(Required)

Yes

Signatures

Title(Required)

Print Name(Required)

Date(Required)

Authorization(Required)

I authorize Members Exchange to pull my consumer credit report.

Additional documentation will be required for processing