QuikApp

Please complete the following information and a representative will contact you as soon as possible regarding your application. Please keep in mind that our minimum loan amount is $150,000.

The information collected from this form will only be used by SBLS and will not be shared with any other entity for any reason.

Contact Information:

Name
Business Name
Address
Address (cont'd)
City, State Zip	,
Phone
FAX
E-mail

How would you prefer to be contacted?

Please give a brief description of your business:

How did you find us?

If you found us through a search engine, what were the key words used?

What is the loan amount you are requesting?

(Must be between $150,000 and $4,000,000 to be eligible for SBLS financing)
$ .00

How much do you have to invest (or have already invested) in the project?

(Minimum 15% of the total project cost for an existing business and 20% of the total project cost for a start-up business to qualify for financing with SBLS)
$ .00

Please give a brief description of how the loan proceeds will be utilized?

Please list and estimate the value of the assets of your business available to collateralize the proposed loan?

(For example: real estate, equipment, inventory, etc.)

How will the requested loan benefit your business?

If the use of funds listed above does not include the purchase of real estate, do you own any real estate that you are willing to pledge as collateral for the project:

Declarations
Please answer the following questions as they may apply to the applicant company, each officer, each director and each owner of 20% or more of the applicant company. For each "yes" we will require a complete signed exhibit providing a detailed explanation from the source.
Yes No	1. Are any involved in any claim or lawsuit?
Yes No	2. Are any federal, state, or local taxes delinquent?
Yes No	3. Are any liable under any contingency agreements?
Yes No	4. Have any ever been involved in bankruptcy or insolvency proceedings?
Yes No	5. Do any have outstanding judgments?
Yes No	6. Have any ever had property foreclosed upon or given title or deed in lieu of foreclosure?
Yes No	7. Have any ever requested government financing before?
Yes No	8. Is this loan request under consideration at any other financial institution at this time?
Yes No	9. Have any ever been charged with or arrested for any criminal offense? (except minor traffic)
Yes No	10. Are any presently under indictment, parole or probation?
Yes No	11. Are any delinquent for child support payments?
Yes No	12. Are any NOT citizens of the United States?