Belco Community Credit Union
BUSINESS LOAN APPLICATION
Completed on ______/______/_______
APPLICANT INFORMATION
Applicant Name Tax ID#/SSN
Date Business Established Date of Present Management
Business Phone Business Fax
Credit Request
Applicant Only Joint With Co-Applicant(s)
We intend to apply for joint credit (Initial below):
Applicant__________________ Co-Applicant__________________ Marital Status (If Individual Borrower)
Married Unmarried Separated Check Appropriate Box
If you are applying for individual credit and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, do not complete the section for marital status.
If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all sections to the extent possible, providing information about the person whose alimony, support or maintenance payments or income or assets you are relying.
If you are applying for joint credit with another applicant, complete all sections and attach joint application.
Business Name (if applicable) Nature of Business
Main Contact Name Email Address
Number of Employees Belco Business Account #
Physical Address Mailing Address
Business Entity:
Sole Proprietorship Corporation S-Corporation LLC General Partnership LLP Non-Profit Other:___________
OWNERSHIP AND GUARANTOR INFORMATION
OWNER/GUARANTOR 1: OWNER/GUARANTOR 2:
Name Name
Title % Ownership Title % Ownership
SSN Birth Date SSN Birth Date
Home Address Home Address
City, State, Zip City, State, Zip
Length of Residence: Own Rent Length of Residence: Own Rent
Marital Status: Unmarried Married Separated Marital Status: Unmarried Married Separated
Home Phone Work Phone Home Phone Work Phone
Employer Name Employment Date Employer Name Employment Date
Annual Income Belco Account Number Annual Income Belco Account Number
BUSINESS FINANCIAL INFORMATION (attach additional pages if needed)
Financial Institution Account Number Type of Account or Loan Current Balance Collateral (If Loan)
Belco Community Credit Union Small Business Lending PH: 717-720-6408 Fax: 717-720-6257 449 Eisenhower Blvd. Harrisburg, PA 17111
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BUSINESS FINANCIAL INFORMATION (continued)
Estimated Annual Revenue (Business Operations) Estimated Annual Expenses (Business Operations)
Estimated Annual Revenue (Rental Properties) Estimated Annual Expenses (Rental Properties)
BUSINESS LOAN REQUEST
Amount of Loan Request:
Purchase
Refinance
Term Requested:
Fixed Rate Period:
5 Years 7 Years 10 Years Other_________
Amortization Requested (in years):
5 7 10 15 20 25 Other_________
Type of Business Loan Requested:
1-4 Family Unit Real Estate Line of Credit Vehicle Purchase Commercial Real Estate
Residential Land Term Loan Construction Loan Commercial Land
Purpose of Loan:
Collateral Offered for Loan Reported Value Source of Value Existing Lien Amount (if applicable)
OTHER INFORMATION
(If “yes” to any of the following, please attach explanatory information)
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
1) Is the business applying for credit from another source?
2) Is the business party to a claim or lawsuit?
3) Are there any delinquent FICA or sales taxes?
4) Has the business or principal(s) ever declared bankruptcy?
5) Does the business owe taxes from a prior year?
6) Does the business have other financial obligations?
7) Are any assets, either business or personal, held in a trust?
8) Does any owner own in excess of 20% of any other business? YES NO
AUTHORIZED SIGNERS FOR THIS APPLICANT
I/We hereby apply for a loan or credit described in this application on behalf of the applicant and/or business. I/We certify that I/we made no misrepresentation in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by the Lender for that purpose. Lender may disclose to any other interested parties information as to Lender’s experiences or transactions with my/our account. I/we understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We further authorize Lender to provide any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.
____________________________ ________ ____________________________ ________
Authorized Signer Date Authorized Signer Date
____________________________ ____________________________
Title Title
____________________________ ________ ____________________________ ________
Authorized Signer Date Authorized Signer Date
____________________________ ____________________________
Title Title
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Belco Community Credit Union
INDIVIDUAL FINANCIAL STATEMENT
Belco Community Credit Union Small Business Lending PH: 717-720-6408 Financial condition as of ______/______/_______Fax: 717-720-6257 449 Eisenhower Blvd. Harrisburg, PA 17111
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Belco Community Credit Union – 449 Eisenhower Blvd. – Harrisburg, PA 17111 – Ph: 717-720-6408 – Fax: 717-
720-6257 –
www.belco.orgAPPLICANT INFORMATION
Complete this form for (1) each proprietor, (2) each limited partner who owns 20% of more interest and each general partner, or (3) each stockholder owning 20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.
Applicant Name SSN
Business Name (if applicable) Phone Number H W Cell Home Address
If assets are owned jointly with spouse, please provide name of spouse:
BALANCE SHEET INFORMATION
ASSETS LIABILITIES
Cash in hand and in Banks $ Accounts Payable $
Savings Accounts $ Notes Payable to Banks & Others
(Describe in Section 2)
$
IRA of Other Retirement Account $ Installment Account (Auto)
Monthly payments: $___________
$
Accounts & Notes Receivable $ Installment Account (Other)
Monthly payments: $___________
$
Cash Value of Life Insurance
(Describe in Section 8) $ Loan on Life Insurance $
Stocks & Bonds
(Describe in Section 3)
$ Mortgages on Real Estate
(Describe in Section 4)
$
Real Estate
(Describe in Section 4)
$ Unpaid Taxes
(Describe in Section 6)
$
Automobile(s) – Present Value $ Other Liabilities
(Describe in Section 7) $ Other Assets
(Describe in Section 5)
$
Total Assets $ Total Liabilities $
Net Worth (Difference between total assets
and total liabilities) $
Section 1: SOURCE OF INCOME** CONTINGENT LIABILITIES
Salary $ As Endorser or Co-Maker $
Net Investment Income $ Legal Claims & Judgments $
Real Estate Rental Income $ Provision for Federal Income Tax $
Other Income (Describe below) $ Other Special Debt (Describe below) $
Description of Other Income/Debt in Section 1:
**Alimony or child support payments need not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income. Section 2: NOTES PAYABLE TO BANK AND OTHERS
Name/Address of Noteholder(s) Original Balance Current Balance Payment Amount How Secured – Type of Collateral
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Section 3: STOCKS AND BONDS
Number of Shares Name of Securities Cost Market Value
Quotation/Exchange
Date of Quotation/Exchange
Total Value
Section 4: REAL ESTATE OWNED
Property A Property B Property C
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name/Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Payment Amount per Month
Section 5: OTHER PERSONAL PROPERTY AND OTHER ASSETS
(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment, and delinquency, if applicable)
Section 6: UNPAID TAXES
(Describe in detail as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)
Section 7: OTHER LIABILITIES (Describe in detail)
Section 8: LIFE INSURANCE HELD
(Give face amount and cash surrender value of policies, name of insurance company and beneficiaries)
I authorize Belco Community Credit Union to make inquiries as necessary to verify the accuracy of the statements made and to determine by creditworthiness. I certify that the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand that false statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001).
Signature: Date: Social Security Number:
Signature: Date: Social Security Number: