Business Loan Application 1st State Bank

Name(Required)

First Last

1. Loan Request

Business must be located in Saginaw, Bay, or Midland County. Maximum Aggregate Credit Exposure $250,000. (Customers with existing loans at 1st State Bank please contact your Business Lender)

Loan Type(Required)

Line of Credit ($150,000 max)

Equipment Loan ($250,000 max)

Real Estate Loan ($250,000 max)

Other ($250,000 max)

Line of Credit Request Amount(Required)

Equipment Loan Request Amount(Required)

Real Estate Loan Request Amount(Required)

Other Loan Request Amount(Required)

Description/Purpose of Loan Request(Required)

Available Collateral

Accounts Receivable

Inventory

Equipment

Vehicle

Real Estate

Other (explain)

Explain "Other" Here

Accounts Receivable Collateral Value

Inventory Collateral Value

Equipment Collateral Value

Vehicle Collateral Value

Real Estate Collateral Value

Other Collateral Value

2. Business Information

Business Classification(Required)

Sole Proprietorship

S-Corporation

C-Corporation

Partnership

Limited Liability (LLC/LLP)

Professional Corporation (PC/PLC)

Individual (Business)

Non-Profit

Business Name(Required)

Tax/Employee Identification Number(Required)

Confirm Tax/Employee Identification Number(Required)

Company Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Phone(Required)

Business Contact Name(Required)

Business Contact Email(Required)

Today's Date(Required)

Date Business Established(Required)

Present Management/Ownership Since(Required)

Recent Year-End Gross Revenue(Required)

Recent Year-End Net Profit (Loss)(Required)

3. Owners/Guarantors

List any Individual who has 20% or more ownership or would be a guarantor of the loan.

Owner/Guarantor #1

Name(Required)

First Last

Title(Required)

Ownership Percentage(Required)

SSN#/TIN#(Required)

Date of Birth(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Owner/Guarantor #2

Name

First Last

Title

Ownership Percentage

SSN#/TIN#

Date of Birth

Phone

Address

Street Address Address Line 2 City State ZIP Code

Owner/Guarantor #3

Name

First Last

Title

Ownership Percentage

SSN#/TIN#

Date of Birth

Phone

Address

Street Address Address Line 2 City State ZIP Code

Owner/Guarantor #4

Name

First Last

Title

Ownership Percentage

SSN#/TIN#

Date of Birth

Phone

Address

Street Address Address Line 2 City State ZIP Code

4. Additional Information

Has the business incurred any loss in the last three years?

Yes

Is the business, owners, or guarantors party to any claim, judgement, or lawsuit?

Yes

Has the business, owners, or guarantors been involved in any bankruptcy proceedings?

Yes

Are more than 20% of revenues from, or expenses to, any related entity?

Yes

Is the business or any of its assets for sale or under agreement for sale?

Yes

5. Signatures

Company Legal Name

Company Representative Title(Required)

Owner/Guarantor #1 - Name(Required)

First Last

Owner/Guarantor #2 - Name

First Last

Owner/Guarantor #3 - Name

First Last

Owner/Guarantor #4 - Name

First Last