Internal Bank Loan Review	
Primary Officer: 		Prepared By: 		
Date Prepared: 			
Loan Request	
Borrower: 		
Business Information:  	Form: 		
	Organ Date: 		
	Type: 		
	Management: 		
	Ownership: 		
Guarantors:     Typically the owner of the business  		
		
Request: 		

Purpose: 		

Terms:  	
Type	Amount	Rate/Fees	Term	Repayment	

					
Source of Repayment	Primary: 		
	Secondary 		
	Tertiary: 		
Collateral Description: 		

Collateral Valuation: 	

Type	Appraised
Value	% of 
ADV	
Debt	Avail.
Equity	LTV	
Accounts Receivable		75% (0-90 days)				
Inventory		30%				
Equipment		75%				
Marketable Securities		70%				
Commercial and Residential
   Property		
75%				
Vacant Land		30-50%				

Flood Hazard: 		
		
Environmental Concerns: 		

Bow Debt:	

Type	
Open	
High	
Bal.	# of REN	
Rate	
Terms	
SEC	
LTV	

									
 Bow Payment History: 		
		
Line of Credit Usage:	
   Low Balance: 		# of Days at Zero: 		
Other Debts: 		
		
Depository Relationship: 	

Name	
Acct #	
Type	
Opened	
Balance	Avg. Col. Bal.	
Rate	

							
Average Cost of Funds: 		
Trust Relationship: 		
Background Information: 		

		

		
Financial Statement: 	Last 3 years of business financial statements and/or tax returns	
	Last 3 years of owner’s personal tax return	
	Current personal financial statement	

	BUSINESS LOAN APPLICATION	
	Date:  		
	New Relationship	Branch:  		
	Existing Relationship	Officer:  		
	
BUSINESS INFORMATION	
Business Name	
Address	
Telephone (     )	Tax I.D.	
Individual Name(s)	
Address	
Telephone (     )	Social Security #	Date of Birth:	
   Proprietorship  		Partnership  		Sub-Chapter S		Corporation  		
        Non-Profit  		Individual  		LLC  		
	
Ownership Distribution:  (List stockholders, partners, owner names)	Note:  Attach separate sheet if additional space needed.	
Name	Title	# of Years	%	SS#	
Name	Title	# of Years	%	SS#	
Name	Title	# of Years	%	SS#	
	
Nature of Business	Year Established	Number of Employees	
Years at Present Location	[   ] Own	[   ] Lease	
Accountant	Telephone (     ) 	
Insurance Agent	Telephone (     ) 	
Attorney	Telephone (     ) 	
	
FINANCIAL INFORMATION	
Bank of Account	Account Number 	
	
Credit Relationships:	Please provide details of your business credit relationships below:	
	
		Original Loan	Amount		Maturity 	
Name of Creditor	Purpose of Loan	Amount	Presently Owing	Repayment Terms	Date	
	$	$	
	$	$	
	$	$	

LOAN REQUEST	
Amount of Loan Requested		Type of loan	
	[         ]	Line of Credit	
	[         ]	Term Loan	
Requested Term of Loan 		[         ]	Business Home Equity	
	[         ]	Commercial Real Estate	
		
Specific Loan Purpose (Check all that apply)		
[         ]	Working Capital		[         ]	Other (State type of loan required and loan 	
[         ]	Finance Purchase of Inventory			    purpose)	
[         ]	Finance Purchase of Equipment	               		
[         ]	Finance Purchase of Real Estate	               		
[         ]	Finance Purchase of Business		               		
[         ]	Refinance Existing Loan or Debts	               		
		
Collateral Available*  (Check all that apply)		
[         ]	All Assets (accounts receivable, inventory, machinery and equipment)	
[         ]	Specific Equipment (Please attach equipment list, including serial numbers or description of 	
	   equipment, and invoices for new equipment.)	
[         ]	Real Estate (Please attach property address, legal description and a copy of most recent tax	
	   bill.)	Square Feet  		Acres  		
[         ]	Cash on Deposit at (name of bank)	Branch  		Account #  		
[         ]	Personal Assets (As described in Personal Financial Statement.)	
	  	
       *	Collateral:  Loans are secured by collateral, which is property in which a security interest is granted to secure repayment of the loan.  The loan collateral may include business assets, stocks, bonds, certificates of deposits, or personal assets.  Consider (1) the value of the loan collateral must be equal to or greater than the amount of the loan, (2) expected economic life of collateral will be considered by the Bank in evaluating the collateral offered for the loan, (3) formal collateral appraisals may be required, and (4) a pledge of personal assets may be required as additional collateral for the business loan requested. 	
	
[         ]	Guarantors** 	(Please list)	
	
	Name	Social Security #	
	Address	
	Name	Social Security #	
	Address	
	Name	Social Security #	
	Address	
		
      **	Guarantors:  For incorporated borrowers, guarantees of owner(s) is usually required, unless secured by Bank deposits or marketable collateral.  If personal assets are in joint names, a sole proprietorship, and/or partnership, the Bank may require all parties to pledge collateral.	

BUSINESS BACKGROUND INFORMATION	
	
Please provide a brief history of your business, future plans and projections, and describe your products and/or services and competition.	

	

	
	
PERSONAL BUSINESS EXPERIENCE	
	
If you have been in your present business for under five years, please describe your previous business experience.  (Include business background, management experience, and training, or include a resume.)	

	

MISCELLANEOUS INFORMATION	
	
Are tax liabilities current?  [   ] Yes  [   ] No  	Settled through  		
Is the business an endorser, guarantor, or co-maker for any obligation not listed in the financial 	statements?	[   ] Yes  [   ] No  	
             If yes, what is the contingent liability? 		
Has the business or principal owner ever declared bankruptcy?	[   ] Yes  [   ] No  	
             If yes, provide details on a separate sheet. 	
Is the business a defendant in any lawsuit?	[   ] Yes  [   ] No  	
             If yes, provide details on a separate sheet. 	
Are any of the business assets encumbered by liens or attachments of any type?    [   ] Yes  [   ] No  	
	What					By whom			Amount $	
	What					By whom			Amount $	
	What					By whom			Amount $	
Does the business have a pension fund?		[   ] Yes  [   ] No  	
			 profit-sharing plan? 	[   ] Yes  [   ] No  	
If so, does the plan have any unfunded pension liabilities?  [   ] Yes  [   ] No  	Amount $	

CERTIFICATION	
	
The undersigned certifies that, to the best of his or her knowledge and belief, all information contained in this loan application and in the accompanying statements and documents is true, complete, and correct.  The undersigned agrees to notify the Bank immediately of any material changes in this information.  It is further agreed that, whether or not the loan herein applied for is approved, the undersigned will pay or reimburse the bank for the costs, if any, of surveys, title or mortgage examinations, appraisals, etc., performed by non-Bank personnel with the consent of the applicant.  The undersigned authorizes the Bank to contact any bank and trade creditors it deems necessary without further notice, including, but not limited to, Dunn & Bradstreet reports or information from TRW Credit Data.	

Business Name (print):			
Applicant Signature:		Date:	
Applicant Title:			
			
Guarantor(s) Signature:		Date:	
Guarantor(s) Signature:		Date:	

	

	
BUSINESS LOAN APPLICATION CHECKLIST	
	
Please be sure all of the following documentation has been included in order for your business loan application to be processed.	
		
	 [   ] Business Loan Application	
	 [   ] Accountant-Prepared Business Financial Statements (Profit and Loss, Balance Sheet) 
	for the past three fiscal years	
	 [   ] Business Federal Tax Returns for past three fiscal years	
	 [   ] Interim Financial Statements (if available)	
	 [   ] Most Recent Federal Tax Returns for each principal owner listed in the first section of 
	the Business Loan Application	
	 [   ] Personal Financial Statement	
	 [   ] Organizational Papers (Articles, dba papers, etc.)	
	 [   ] OTHER: