Commercial Loan Application

3. Have you requested financing for this purpose from another bank? Yes No

4. Use of proceeds; identify amounts in each category:    

Application For

Commercial Loan

Date:________

The information that is required for the completion of this application is needed for the Union Bank to make a valid decision to grant or not grant the loan applied for. Current economic conditions and the constraints placed on banks by supervisory authorities require more information on file to justify lending practices. Thus, even long time customers must furnish much of the same type of information as do new borrowers. We trust that you will understand the need for the completion of this application in full, including all other documents requested.

Information Regarding Applicant

Name of Borrower: Tax ID/SSN:

Trade Name: E-mail Address:

Physical Address: City, ST, Zip:

Mailing Address: City, ST, Zip:

Business Location:

Telephone:

Name of Current Financial Institution:

Office Location:

Name and Address of Nearest Relative NOT Living with you

Driver’s License Number & State

Nature of Business Reason for Funds

Proprietorship Purchase existing business

Partnership New business start-up

Corporation Franchise (need agreement)

Existing business Other (describe)

Date established

Number of employees:

Briefly describe business:_________________________________________________________________________

Loan Request

1. Amount: $ Term: Monthly Payments: $

2. Secured: Unsecured Guarantors:

a. Acquisition of all/part of business: $ f. Purchase inventory: $

b. Land acquisition: $ g. Payoff or refinance debt: $

c. New building; construction: $ h. General working capital: $

d. Building expansion or repair: $ i. All other: $

e. Purchase machinery or equipment: $ Total loan request: $

Commercial Loan Application

Collateral Valuation

Collateral Fair market value Less: Liens = Net Value

1. Land and buildings $ $ $

2. Machinery and equipment $ $ $

3. Furniture $ $ $

4. Accounts receivable $ $ $

5. Inventory $ $ $

6. Other $ $ $

Total collateral value: $ $ $

Information Regarding Ownership and Management

Please list all owners, officers, directors and stockholders who own 20% or more of the outstanding stock of the business.

Also list those non-owners or stockholders employees in management positions. (Please use an additional sheet if

necessary)

Name SSN Address % Owned Annual Comp

1.   % $

2.   % $

3.   % $

4.   % $

On a separate sheet of paper provide the following information:

1. A summary of the educational, technical, business background and experiences of the key people in this business

operation.

2. A brief history of the business, describe current operations (marketing strategies, credit policies currently in use), the

competition, both local and national, and your plans for changes in the near future. Describe how the business will

benefit from the loan you are requesting and the changes it will help to bring about.

Financial Statements Needed

All of these forms, returns, reports and projections must be signed and dated before submitting with this application.

1. For all applicants:

a) Provide copies of the personal income tax returns for each owner, partner, stockholder, and co-signer or

guarantor for the past three years.

b) Provide a personal financial statement of each owner, partner, stockholder, and co-signer or guarantor.

2. For an existing business:

a) Complete financial statements of business (balance sheet and profit/loss statements) prepared by an

independent accountant, if possible, including an aging of accounts receivable and accounts payable.

b) Provide copies of business federal tax returns for the past three years.

3. For a new business:

a) Provide information relative to the source and amount of equity capital for investment in the new

business.

Business Projections

1. For an existing business:

a) Provide a projected profit/loss statement (revenues and expenses, including identified owner withdrawals)

for the next full fiscal year.

b) Briefly explain your assumptions included in that projection (cost controls, sales growth and profit

margins)

2. For new business startups:

a) Prepare and provide a pro-forma balance sheet listing the assets and liabilities of the business on the first

day of operations.

b) Prepare and provide a profit/loss statement for the next full fiscal year.

c) Prepare and provide a cash flow summary for the next 12 months.

Certification (Please read carefully)

Each of the undersigned represents; warrants and certifies that the information provided here within is true, correct and complete. Each of the undersigned agrees to notify the bank immediately and in writing of any change in name, address, or employment and of any material or adverse change (1) in any of the information contained in this application or (2) in the financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform its (or their) obligations to the bank. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. The bank is authorized to make all inquiries it deems necessary to verify the accuracy of the information contained herein, and to determine the credit worthiness of the undersigned. The undersigned agrees to pay for, or reimburse, Union Bank for the cost of any surveys, title searches, appraisals, etc. performed by non-Union Bank personnel, provided the undersigned has advance knowledge of the costs and has/have given consent to the expenditure. The undersigned applicant authorizes Union Bank to answer questions of credit reporting agencies about the bank’s credit experience with the undersigned applicant.

I/We authorize disclosure of any and all information submitted in connection with this application to any financial institution interested in participating in this financing. I/We certify that the information provided with the application is true and complete. I/We authorize the Bank to investigate the credit history of the applicant business and its owner(s).

If applicant is a proprietor or general partner, sign below:

By:

If applicant is a corporation, sign below:

Corporate Name

By:

Authorized Agent

  Personal Financial Statement

Date: _______________

   Please complete all sections and sign on the last page.

 If you are applying for individual credit in your own name 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 cred it requested, or if this statement related to your guaranty of t he indebtedness of other person(s), firm(s), or corporation(s), complete only Sections 1, 3 and 4.

 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 a basis for repayment of the credit requested, complete all sections. Provide information in Section 2 about the person whose alimony, support, or maintenance payments or inco me or assets you are re lying on. Alimon y, child support, or separate maintenance income, or separate maintenance income, need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

SECTION 1 – Individual Information SECTION 2 – Other Party Information

Name: Name: Address: Address:

City, ST, Zip: City, ST, Zip:

Residence Phone #: Residence Phone #:

Business Phone #: Business Phone #:

E-Mail Address: E-Mail Address:

Position\Occupation: Position\Occupation:

Business Name: Business Name:

Business Address: Business Address:

City, ST, Zip: City, ST, Zip:

Social Security #: Social Security #:

Date of Birth: Date of Birth:

Driver’s License #: Driver’s License #:

Length at Present Address: Length at Present Address:

Length of Employment: Length of Employment:

Name and Address of Nearest Relative Not Living With You:

Name and Address of Nearest Relative Not Living With You:

Have (either of) you or any firm in which you were a major owner ever declared bankruptcy, or settled any debts for less than the amounts owed?

Yes No

If “yes” please provide details on separate sheet.

Are (either of) you a defendant in any suit or legal action? Yes No Are (either of) you presently subject to any unsatisfied judgments to tax liens? Yes No

When, if ever, have (either of you) been audited by the IRS? Never Year(s): .  

SECTION 3 – Statement of Financial Condition

Schedule A – Cash, Checking and Savings Accounts, Certificates of Deposit, Money Market Funds, Etc.

Name of Financial Institution Type of Account Owner Joint If Pledged, to Whom? Balance

Schedule B – U.S. Government & Marketable Securities (use additional sheets if necessary)

# of Shares or Face Value of Bonds

Description

In Name of

Are these Registered, Pledged, or Held by Others?

Market Value

Exchanges Where Traded?

Personal Financial Statement

Schedule C – Non-Marketable Securities (use additional sheets if necessary)

# of Shares  

Description

In Name of

Are these Registered, Pledged, or Held by Others?

Value  

Method of Valuation

Schedule D – Investments in Real Estate (use additional sheets if necessary)

Description/ Location of Real Estate Investment

Joint

Date & Amount of Original Investment

% Owned by You

Market Value of Your % of Investment

Present Mortgage Balance

Monthly Payment

Mortgage Maturity Date

Mortgage Owed to

Schedule E – Life Insurance Carried, Including Group Insurance

Name of Insurance Company

Owner of Policy Beneficiary and Relationship

Face Amount  

Policy Loans

Cash Surrender Value

Schedule F – Vested Interest in Deferred Compensation/Profit-Sharing Plans

% Vested

Company Name  

Account Number

Manner of Payout (Annuity, Lump Sum, etc.)

Distribution Date

Beneficiary Amount

%

%

%

Schedule G – Business Ventures (use additional sheets if necessary)

List Name and Address of Any Business Venture in Which You Are a Principal or Partner

  Your Position/ Title

Line of Business

Years in Business

Total Assets

Your % of Ownership

Net Worth of Business

Present Net Value of Your Investment

Schedule H – Loans Owing Banks, Brokers, Finance Companies, and Others (use additional sheets if necessary)

Owing To (Acct. No.)

  Joint

Date/Amount of Original Borrowing

Present Balance

Next Due Date

Monthly Payment

Date of Final Payment  

Secured by

Summary - Statement of Financial Condition

AS OF: ASSETS

(Do not include assets of doubtful value)

In dollars Individual

If joint with whom? LIABILITIES

In dollars Individual

If joint with whom? Cash, Checking & Savings, CD’s –

See Schedule A

Notes Payable to Banks &

Others– See Schedule H

US Govt. & Marketable Securities –

See Schedule B

Real Estate Mortgages Payable

– See Schedule D

Non-marketable Securities –

See Schedule C

Restricted, Control or Margin Account

Stocks

Amounts Payable to Others –

Secured

Real Estate Owned – See Schedule D

Amounts Payable to Others –

Unsecured

Cash Surrender Value of Life Insurance –

See Schedule E

Vested Interest in Deferred Compensation /

Profit-Sharing Plans – See Schedule F

Business Ventures – See Schedule G

Accounts, Loans & Notes Receivable

Automobiles

Other Assets/Personal Property:

TOTAL ASSETS

SECTION 4 – Annual Income for Last Fiscal Year

Annual Income Individual Joint Annual Expenditures Individual Joint Contingent Liabilities Estimated Amounts

Salary, Bonuses & Commissions

Dividends & Interest

RE Taxes & Assessments

Contingent liabilities as endorser, co-maker or guarantor?  

Real Estate Income

Income Taxes –

Federal, State, Local

Contingent liabilities on leases or contracts?

Other Income

(Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.)

Other Loan Payments (Car,

charge cards etc.)

Alimony, Child Support

Any estimated capital gains tax on the unrealized assets appreciation?  

Other Expenses

TOTAL INCOME

TOTAL EXPENDITURES

If you answered “yes” to any questions please provide details on a separate sheet.

Certification (Please read carefully)

The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guaranty of the undersigned. The undersigned acknowledges and understands that you are relying on the information provided herein in deciding to grant or continue credit or to accept a guaranty thereof. Each of the undersigned represents, warrants and certifies that

(1) the information provided herein is true, correct and complete and gives a correct and complete showing of the financial condition of the und ersigned,

(2) the undersigned has no liabilities direct, indirect or cont ingent except as set forth in this statement, and

(3) legal and equitable title to al l assets listed herein is in the undersigned’s sole name, except as may be herein otherwise noted.

Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or

Employment, and of any material adverse change in any of the information contained in this statement or in the financial condition of any of the undersigned or in the ability of any of the undersigned to perform its (or their) obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein, and to determine the credit-worthiness of the undersigned and the undersigned hereby authorizes all p ersons of whom you make such inquiries to respond thereto in full. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned.

Signature (individual) Date Signature (other party) Date

This form is signed for the purpose of applying for individual or joint credit. (Check one)

FACTS  

Why? Financial companies choose how they share your personal information. Federal law gives consumers

the right to limit some but not all sharing. Federal law also requires us to tell you how we collect,

share, and protect your personal information. Please read this notice carefully to understand what we

do.

What? The types of personal information we collect and share depend on the product or service you have

with us. This information can include:

 Social Security number  Credit history

 Account balances  Credit scores

 Transaction or loss history  Account transactions

When you are no longer our customer, we continue to share your information as described in this

notice.

How? All financial companies need to share customers' personal information to run their everyday business.

In the section below, we list the reasons financial companies can share their customers' personal

information; the reasons Union Bank chooses to share; and whether you can limit this sharing.

Reasons we can share your personal information Does Union Bank share? Can you limit this sharing?

For our everyday business purposes -

such as to process your transactions, maintain your

account(s), respond to court orders and legal

investigations, or report to credit bureaus

Yes No

For our marketing purposes -

to offer our products and services to you

Yes No

For joint marketing with other financial companies Yes No

For our affiliates' everyday business purposes -

information about your transactions and experiences

Yes No

For our affiliates' everyday business purposes -

information about your creditworthiness

No We don't share

For our affiliates to market to you No We don't share

For nonaffiliates to market to you No We don't share

Questions? Call 802.888.6600 or Toll-free at 800.753.4343 or go to www.UBLOCAL.COM

WHAT DOES UNION BANK DO WITH YOUR PERSONAL INFORMATION?

Privacy Model Disclosure PRIV-MODEL 8/1/2010

VMP® Bankers Systems™

Wolters Kluwer Financial Services © 2010 2012.1/2249 3325227-010 Custom EPRV2249

Page 2  

What We Do  

How does Union Bank protect

my personal information? To protect your personal information from unauthorized access and use, we use

security measures that comply with federal law. These measures include computer

safeguards and secured files and buildings.

We also maintain other physical, electronic and procedural safeguards to protect

this information and we limit access to information to those employees for whom

access is appropriate.

How does Union Bank collect my

personal information? We collect your personal information, for example, when you

 Open an account  Pay us by check

 Apply for a loan  Make a wire transfer

 Make deposits or withdrawals from

your account

We also collect your personal information from others, such as credit bureaus,

affiliates, or other companies.

Why can't I limit all sharing? Federal law gives you the right to limit only

 sharing for affiliates' everyday business purposes - information about your

creditworthiness

 affiliates from using your information to market to you

 sharing for nonaffiliates to market to you

State laws and individual companies may give you additional rights to limit sharing.

See below for more on your rights under state law.

Definitions  

Affiliates Companies related by common ownership or control. They can be financial and

non-financial companies.

 Our affiliates include our parent holding company Union Bankshares, Inc.

Nonaffiliates Companies not related by common ownership or control. They can be financial and

non-financial companies.

 Union Bank does not share with nonaffiliates so they can market to you.

Joint Marketing A formal agreement between nonaffiliated financial companies that together market

financial products or services to you.

 Our joint marketing partners include credit card, insurance, and leasing

companies as well as securities brokers, financial planners, investment

advisors, trust and investment management companies, mortgage banking and

similar services.

Other Important Information

As required by Vermont law -

 We obtain your consent before accessing your credit report and use it only for the purpose for which you consented.

 We do not share your health and medical information, except to process transactions or to provide services you have

initiated.

  Consent

I ( We) hereby give my ( our) consent to have Union Bank obtain any and all information regarding my (our)

employment, checking, and/or savings accounts, credit obligations and all other credit matters which they may

require in connection with my (our) application for a loan.

I understand that a consumer report prepared by a consumer reporting agency may be obtained at the time I

apply for my account and, if my account is approved, at any time after that. I have the right at any time to ask

Union Bank whether a report was obtained and , i f s o, to have Union Bank furnish me with the name and

address of the consumer reporting agency that prepared the report.

THIS FORM MAY BE REPRODUCED AND THAT COPY SHALL BE AS

EFFECTIVE AS THE ORIGINAL CONSENT WHICH I (WE) HAVE SIGNED.

This consent form is signed for the purpose of applying for individual or joint credit. (Check one)

Signature Signature

I am (we are) aware t hat t he assigned Credit Bureau m ay call m e ( us) t o clarify information obtained i n m y ( our) application or credit history (ies) in order to expedite the processing of the loan application. I (we) can be reached at the following telephone number(s) during the day.

Name: ( _)_ from to

Name: ( )_ from to

FOR BANK USE ONLY

I hereby certify this to be a true and exact copy of the original

Signature Name/Title  

Consent Form