Small Business Loan Questionnaire
*Name    
Title    
*Business Name    
Street Address    
Address (cont.)    
City    
*State    
Zip Code    
*Work Phone    
FAX    
*E-mail    
Web Site    
Loan Proceeds:
*Loan Amount Requested $
Loan Purpose:
Increase Inventory
Payoff/Consolidate Existing Debt
Purchase New Equipment
Additional Working Capital
Plant Expansion Or Remodel
Build Or Purchase A Building
Accounts Receiveable Financing
Refinance Owner-Occupied Property
Start A New Business
Purchase An Existing Business/Franchise
Business Ownership:
Sole Proprietorship
Partnership
Corporation
Limited Liability Partnership
Limited Liability Corp.
Type of Business:
Franchise
Retail Sales
Service
Wholesale
Manufacturer
Business Facts:
Annual Sales
$
Number Of Employees:
Number of Individuals owning 20% or more of the business?
How Long in Business:
Personal Credit:
How would you rate your personal credit?
Great   Good   Fair   Poor  
*Have you declared bankruptcy in the last seven years?
Yes   No  
If yes, please explain?

Additional Comments Regarding Your Business



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