Business Credit Application

MEMBER BUSINESS CREDIT APPLICATION

Amount Requested *	Term of Loan *


Loan Purpose *	Collateral


Application for *	Other




MEMBER BUSINESS INFORMATION

Business Name *	DBA Name


Principal Place of Business (not P.O. Box)*


City *	State *	Zip *


Mailing Address (if different)


City	State	Zip


Primary Contact Name *


Business Telephone *	Business Fax *


Date Business Established *	# of years under current ownership *


State of Registration *	Annual Sales *


Describe Products/Services *


Current Number of Employees *	Email Address *


Type of Ownership (Select One) *	Tax ID # *


Does applicant have any open deposit or loan accounts with Credit Union?	Business Share Draft Account with Credit Union
Yes No



OWNER'S INFORMATION

1) Full Legal Name *	Title *	% Owned *


Email *	Social Security # *




2) Full Legal Name	Title	% Owned


Email	Social Security #




3) Full Legal Name	Title	% Owned


Email	Social Security #







ACCOUNT DISCLOSURES

1) Name of Institution or Broker	Type of Account	Account Number


When Opened	Current Balance




2) Name of Institution or Broker	Type of Account	Account Number


When Opened	Current Balance





1) Current Loans: Name of Lender	Rate	Monthly Payment


Collateral Description	Current Balance


2) Current Loans: Name of Lender	Rate	Monthly Payment


Collateral Description	Current Balance


3) Current Loans: Name of Lender	Rate	Monthly Payment


Collateral Description	Current Balance




ADDITIONAL INFORMATION

Has applicant ever obtained credit under another name?		Yes No

Is applicant liable for debts not shown, including any contingent liabilities such as leases, endorsements, guarantees, etc?		Yes No

Has applicant ever declared bankruptcy or had any judgments, garnishments, repossessions, or other legal proceedings filed against them?		Yes No

Is applicant currently a defendant in any suit or legal action?		Yes No

Are there any tax obligations, including payroll or real estates past due?		Yes No

Does any customer or supplier currently account for more than 20% of your business?		Yes No




Comments


Your Name *	Your Title *	Your Email *


* Required Fields

FOR INFORMATION

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Saturday
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