Last Name
First Name
Middle Initial
Company Name
Address
City
State
Zip
Phone
Fax
E-mail
Website
Type of Business: Choose one-
Corporation
Sole Proprietor
Partnership
If Corporation:
Limited Liability Company
Subchapter S
Other
If Partnership:
Limited
Other Do you have a written agreement?
Yes
No
Please enter numerical numbers rounded to
nearest dollar and omit punctuation, for example: for $100,000.00, please
enter 100000.
Loan Amount:
List how you are allocating
the loan proceeds, place each item and amount on a separate line. For
example, if you are spending $40,000 on equipment, place "Equipment,
$40,000" on one line. *This box is for your use only. The
bank will need to know how you are allocating the funds.