Commercial Loan Application

Loan Information

(See Estimated Project Costs for Requested Loan Amount)

Borrower Information

Contact Information

Illegal Activity

Are you presently under indictment, on parole, or on probation?

Have you ever been charged with, arrested, and/or convicted of any criminal offense other than a minor motor vehicle violation?

Estimated Project Costs

Costs/Uses of Funds. Please outline the use of funds in the space below. Be as specific as possible.

  Total Costs Comments
10% – 30% or greater borrower's cash investment depending on project

Ownership of Applicant Company

(Show 100% of ownership, including all proprietors, partners, officers, directors, and any holders of outstanding stock.)

Name/Title % Owned Compensation Active? Citizen? Green Card?

Sources of Capital Injection/Equity

When purchasing Real Estate, Equipment, or other assets, between 10% – 30% or more may be required as cash injection toward the purchase. Please list the location of the funds to be used as capital/cash injection.

Amount Where Funds Are Held or Source of Equity Injection

Collateral for this Loan

Additional Information

Has any applicant filed for Bankruptcy in the past?

Do applicants owe any past taxes?

Have you prepared a Business Plan?

Have you completed cash flow projections?

Principal Investors

Affiliates

List below all business concerns in which the Applicant Company or any of the individuals listed in the ownership section above have any ownership.

Company Name Name, Type of Ownership % of Ownership


If you need further assistance or information, please contact an AmeriState account representative at (800) 522-4079.

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