Business Loan Application
Business Name (and trade name if applicable):
Taxpayer ID#:
Telephone #:
Business Structure (check one): ☐Proprietorship ☐General Partnership ☐Limited Partnership ☐Corporation ☐Other
Street Address City/Town State Zip Code
Mailing Address (if different from above) City/Town State Zip Code
Description of Business:
Business Facilities at Other Locations:
Street Address City/Town State Zip Code
Street Address City/Town State Zip Code
Loan Requirements
Amount Requested Type and Term Requested Purpose
$
$
$
Please check one:
☐Loan payment will be automatically deducted from my Wallkill Valley Federal S&L business checking account:
☐No loan payments will be automatically deducted from my business account. (Note: a higher interest rate may be imposed.)
Depository Accounts (use separate sheet if necessary)
Bank Name Account Name Account Number & Type Estimated 12 mo. Average Balance
1.
2.
3.
Management (proprietor, partners, officers, directors owning 20% or more of the business)
100% ownership must be shown. Use separate sheets if necessary.
Name/Title Address & # yrs. at such Social Security Number Date of Birth Tenure (yrs. in position) % Owned
1.
2.
3.
4.
5.
Business References
Bank or Financial Institution Name and Address Telephone Number Contact Person(s)
Bank or Financial Institution Name and Address Telephone Number Contact Person(s)
Attorney Name of Firm and Address Telephone Number Contact Person(s)
Auditor or Accountant Name of Firm and Address Telephone Number Contact Person(s)
Other Credit Relationships (use separate sheet if necessary)
Name of Lender or Trade Creditor Purpose of Loan Original Amount/Limit Outstanding Balance Interest Rate Repayment Terms
1.
2.
3.
4.
5.
6.
7.
Business Assets and Proposed Collateral (Please indicate security available and estimated market value)
Description: Fixed assets/accounts Title in name of Estimated market value Existing encumbrances
receivable/Securities/inventory/other
1.
2.
3.
Miscellaneous Obligations
Is the business or any principal an endorser, guarantor or cosigner for the obligations not listed on its financial statements? ☐Yes ☐No
If yes, please estimate total contingent liability: $
Is the business or any principal a party to any claim or lawsuit? ☐Yes ☐No
If yes, please provide details briefly:
Has the business or any principal ever been in receivership or declared bankruptcy? ☐Yes ☐No
If yes, please provide details briefly:
Are any of the individuals (a) presently under indictment, on parole or probation, or have they ever been (b) charged with any criminal offense other than a minor traffic violation, or (c) convicted, placed on pretrial diversion, or placed on any form of probation for any criminal offense other than a minor traffic violation? ☐Yes ☐No
If yes, please provide details briefly:
Additional Information Requirements
I. Each majority stockholder, partner and/or owner must submit a complete personal financial statement.
II. Include the statements listed below:
1. Company’s Fiscal Year End Balance Sheet and Income Statement and/or Company’s Income Tax Returns for the last three years
2. Personal Income Tax Returns of majority stockholders, partners and/or owners
3. Listing an Aging of Accounts Receivable and Accounts Payable
III. Provide a brief history of your company and management (if new borrower) as well as a statement describing the expected benefits from the loan.
Submit this application along with the materials outlined above to: Wallkill Valley Federal Savings & Loan, 23 Wallkill Avenue, Wallkill, NY 12589
Declaration
The undersigned hereby declares that all the information provided herein and on the accompanying statements is to the best of my knowledge true, complete, correct and understand it will be used by the Bank to determine creditworthiness. The proceeds of the loan(s) applied for will be used for business purposes and not for personal, family or household purposes. The Bank is hereby authorized to request a consumer report on any person(s) whether or not a consumer report was requested and if requested, the name and address of the consumer-reporting agency that furnished the report. If an appraisal is ordered in connection with the load application, on a dwelling, defined as a one to four family residential structure including mobile homes an individual cooperative apartments, the applicant may request the Bank to provide a copy of the appraisal report. If you wish to receive a copy of such, please address your written request to Wallkill Valley Federal Savings & Loan , 23 Wallkill Avenue, Wallkill, NY 12589. We have the right to request reimbursement from you for the cost of all or any appraisals ordered in connection with this application for credit. We must hear from you no later than 90 days after we notify you about the action taken on your credit application or your application will be considered withdrawn. Every person signing this statement further authorizes the Bank to make all necessary inquiries to verify the information in this statement and also authorizes all such persons or entities the Bank contacts to completely respond to such inquiries.
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OFFICIAL USE ONLY:
Date Received Initials