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Last NameFirst Name
Address City State Zip
M.I
Page 1 of 8
Small Business Loan Application
Gender DOB
Immigration Status
Marital Status
Today's Date
Loan Information
Applicant (You may apply for credit in your name alone, regardless of your marital status)
Partnership Limited Liability Company Corporation Sole Proprietorship Entity Type:
Date Established Employer/Tax ID No.
Company Address Suite No.
City
Cell Number
Cell NumberSecondary Contact
Primary Contact
WebsiteFaxPhone
ZipState
Loan Amount Requested
Household Income (Annual) Household Size:
Adults
Children
SSN#
Business Status
Company Ownership (List All Owners, Principals and Officers) Title % Of Ownership
TOTAL (Must Total 100%):
If, "YES," provide the name(s) of the bank(s) and approximate date(s) of the denial(s) in the space below:
NOYESHave you been turned down for credit elsewhere?
Name of Financial Institution Date of Credit Denial Name of Loan Officer
Business Name
Applicant:
Children
Adults
Household Size:Household Income (Annual)Immigration Status
Marital StatusEthnicityDOBGender
ZipAddress
SSN#M.IFirst NameLast Name
Co-Applicant:
Ethnicity
City State
Application fee: Nanoloan (<$10,000): $35 Microloan (<$50,000): $70 Enterprise loan (<$250,000): $115
NOYESIs applicant eligible for traditional bank financing?INTERNAL USE ONLY:
Veteran
Veteran
Note that you cannot save this form. Please print upon completion.
Page 2 of 8
Loan Information (continued)
Purpose of Loan (List a Brief Description for Use of Funds): Provide information on collateral available to secure the loan above:
Description Cost
Equipment
Tenant Improvements
Refinance
Commercial Real Estate
Working Capital
Other (Specify)
Other (Specify)
Total
Type Market Value
AGREEMENT By signing below, you certify that all the information you have given with this application is true and complete. You authorize us to verify all your statements with any source, obtain credit and employment history (including your spouse, if you live in a community property state) and exchange information with others about your credit and accounts experiences. You agree to provide additional information that we may require to process this application, including but not limited to true and complete federal income tax returns, employment and income verification. You also agree to reimburse us for our expenses incurred in connection with any credit commitment. These expenses include without limitation appraisal costs, fees for environmental services and legal fees which are payable even though the extension of credit may not be consummated. You acknowledge that your are applying for credit under the terms of a Government business loan assistance program.
Authorized Signature Date
NoYesHas this business or a business you owned or any of the principals ever filed bankruptcy or defaulted on any debt?
NoYesIs the business an endorser, guarantor, or co-maker for obligations not listed in its financial statements?
NoYesAre there any assets pledged or mortgaged other than as stated on business and personal financial statements submitted?
Yes NoIs the business or any of the principals a party to any claim, lawsuit, shortsale, lender loss, or foreclosure?
Yes NoDoes the business owe any taxes for years prior to the current year?
Yes NoDoes your business maintain key-person life insurance on any owner, officer, or shareholder?
Yes NoDoes the Applicant use or Store any Hazardous or Toxic Materials, or Produce Hazardous or Toxic Waste?
Authorized Signature Date
Additional Notes: Collateral
Are you an 'insider' (executive officer, director, staff, or loan committee member) of Fresno CDFI? Yes No
NoYesDo you own or control another business? If yes, name of company ________________ % of ownership: _________%
NoYesHave you ever voluntarily surrendered or had a vehicle or any other item repossessed?
NoYesAre you presently on parole, or probation?
NoYesAre there any suits or judgements now pending against you?
How much $ are the business owners prepared to inject into this project?
Print Name Title Print Name Title
Personal Financial Statement
ASSETS Amount LIABILITIES Amount
Cash on hand & in Banks Accounts Payable
Saving Accounts Notes Payable to Banks and Others (Describe in Section 2)
IRA or Other Retirement Account Installment Account (Auto)
Accounts & Notes Receivable Installment Account (Other)
Life Insurance-Cash Surrender Value Only (Complete Section 8) Loan on Life Insurance
Stocks and Bonds (Describe in Section 3) Mortgages on Real Estate (Describe in Section 4)
Real Estate (Describe in Section 4) Unpaid Taxes (Describe in Section 6)
Automobile-Present Value Other Liabilities (Describe in Section 7)
Other Personal Property (Describe in Section 5)
Other Assets (Describe in Section 5)
Total Assets Total Liabilities
Net Worth (Difference between Total Assets and Total Liabilities)
Section 1. Source of Income (annual) Expenses (annual)
Salary Rent or Mortgage Payment
Net Investment Income Estimated Living Expenses (food, gas, etc)
Real Estate Income Child Support/Alimony Expense
Other Income (Describe Below)*
Description of Other Income in Section 1.
*Alimony or child support payments need to be disclosed in "Other Income" unless it is desired to have such payments counted towards total
Section 2. Notes Payable to Banks and Others (Use attachments if necessary. Each attachment must be identified as part of this statement and signed)
Name and Address of Noteholder(s) Original Balance Current Balance Payment Amount Pymt Frequency (monthly, etc)
How Secured or Endorsed Type of Collateral
Page 3 of 8
Personal Financial Statement (continued)
Number of Shares Name of Securities Cost Market Value Quotation/Exchange
Date of Quotation/Exchange
How Secured or Endorsed Type of Collateral
Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as part of this statement and signed.)
Section 4. Real Estate Owned. (List each parcel separately. Use attachment if necessary. Each attachment must be identified as part of this statement and signed.)
Page 4 of 8
Property A Property B Property C
Address
Date Purchased
Original Cost
Present Market Value
Name and Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Mortgage Payment Per Month
Rental Income Per Month
Section 5. Other Personal Property and Other Assets.
Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)
Section 7. Other Liabilities. (Describe in detail.)
Section 8. Life Insurance Held. (Describe in detail.)
Authorized Signature Date Authorized Signature Date
I authorize the SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I/we certify the above and the statements contained in the attachment are true and accurate as of the stated dates(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I/we understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S Attorney General (Reference 18 U.S.C 1001). I/we authorize Fresno Community Development Financial Institution to disclose the status of the proposed financing transaction and the credit information concerning the business applicant and/or the owner(s)/guarantor(s) to referral sources, loan participate or other lenders concerning or related to the proposed transaction.
Page 5 of 8
Business Profile (attach additional pages if more space is needed)Nature of Business (Describe the type of business you are in)
How will this Loan Benefit your Business?
Products/Services Offered
Customer Profile (What are the primary markets for your products/services?)
Other comments about your loan request
Page 6 of 8
Job CreationProjected Jobs (To be Hired in the Next 3 Months)Current Jobs (Including Owners)
Position Title # of Positions Hours/week per Job Position Title # of Positions Hours/week per Job
Other relevant management / staff experience
Management ProfileWork Experience (or attach resume)
ToCompany Name/ Location
TitleDuties
ToFrom Company Name/ Location
TitleDuties
ToFrom Company Name/ Location
TitleDuties
From
Company Name/ Location From To
Duties Title
Education
Degree/CertificateMajorDurationCollege or Technical Training
Other job creation / retention notes
Page 7 of 8
Creditor Name Original Amount Current Balance % Rate Term Payment (mo.) Collateral
Business Debt Schedule (excluding personal debt)
Real Estate Schedule
Property Address Creditor Original Amount
Current Balance
Property Value % Rate Term Monthly
Payment
Projections
Complete 12 months of income/expenses for the following year. You may attach your own set of projections.
Pre-Startup TotalMonth 1
Advertising
Car, delivery & Travel
Accounting & Legal
Rent
Telephone
Utilities
Insurance
Taxes (Real Estate, etc.)
Total Expenses (TE)
Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11
Page 8 of 8
Net Income (REV minus TE)
Revenue (REV)/Income
TotalMonth 11Month 10Month 9Month 8Month 7Month 6Month 5Month 4Month 3Month 2Month 1
Expenses
Month 12
Month 12
Other Specify
Other Specify
Other Specify
Other Specify