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COMMERCIAL LOAN APPLICATION

TYPE OF CREDIT REQUESTED AND TERMS OF LOAN

Loan Amount Requested *

Purpose of Business Loan *

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BORROWER INFORMATION

Applicant is: *

Are you applying for Joint Credit? *

Yes

No

Business Name *

Do you have an EIN#? *

Yes

No

EIN# *

Business Address, City, State, Zip *

Business Phone *

State of Organization *

Name of Member/Officer of Business Entity (Guarantor) 1 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Additional Member/Officers (2)? *

Yes

No

Name of Member/Officer of Business Entity (Guarantor) 2 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Additional Member/Officers (3)? *

Yes

No

Name of Member/Officer of Business Entity (Guarantor) 3 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Additional Member/Officers (4)? *

Yes

No

Name of Member/Officer of Business Entity (Guarantor) 4 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Additional Member/Officers (5)? *

Yes

No

Name of Member/Officer of Business Entity (Guarantor) 5 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Additional Member/Officers (6)? *

Yes

No

Name of Member/Officer of Business Entity (Guarantor) 6 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Additional Member/Officers (7)? *

Yes

No

Name of Member/Officer of Business Entity (Guarantor) 7 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Additional Member/Officers (8)? *

Yes

No

Name of Member/Officer of Business Entity (Guarantor) 8 *

SSN/EIN # *

Date of Birth * +

Address, City, State, Zip *

Primary Phone *

Primary Email

Borrower

Name *

SSN *

Date of Birth * +

Primary Phone *

Primary Email *

Address *

City *

State *

ZIP *

Co-Borrower

Name *

SSN *

Date of Birth * +

Primary Phone *

Primary Email *

Same as Borrower's Address *

Yes

No

Address *

City *

State *

ZIP *

Check Appropriate Box

If you are applying for individual credit and are relying on your own income or assets and not the income of assets of another person as the basis for repayment of the credit requested, do not complete the section for marital status.

If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all sections to the extent possible, providing information about the person whose requested, complete all sections to the extent possible, providing information about the person whose alimony, support or maintenance payments or income or assets you are relying.

If you are applying for joint credit with another applicant, complete all sections and attach joint application.

Marital Status *

Married

Unmarried

Separated

COLLATERAL OFFERED

Type of Collateral *

Property Type *

Description of Collateral (if applicable, VIN#, Serial #, Hull #) *

Value of Collateral *

Total Liens

Property Address, City, State, & Zip *

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County *

Additional Collateral Offered (2): *

Yes

No

Type of Collateral (2) *

Property Type (2) *

Description of Collateral & if applicable, VIN#, Serial #, Hull # (2) *

Value of Collateral (2) *

Total Liens (2)

Property Address, City, State, & Zip (2) *

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County (2) *

Additional Collateral Offered (3): *

Yes

No

Type of Collateral (3) *

Property Type (3) *

Description of Collateral & if applicable, VIN#, Serial #, Hull # (3) *

Value of Collateral (3) *

Total Liens (3)

Property Address, City, State, & Zip (3) *

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County (3) *

Additional Collateral Offered (4): *

Yes

No

Type of Collateral (4) *

Property Type (4) *

Description of Collateral & if applicable, VIN#, Serial #, Hull # (4) *

Value of Collateral (4) *

Total Liens (4)

Property Address, City, State, & Zip (4) *

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County (4) *

Additional Collateral Offered (5): *

Yes

No

Type of Collateral (5) *

Property Type (5) *

Description of Collateral & if applicable, VIN#, Serial #, Hull # (5) *

Value of Collateral (5) *

Total Liens (5)

Property Address, City, State, & Zip (5) *

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County (5) *

ENVIRONMENTAL RISK ANALYSIS

PROPERTY 1: Please select the appropriate responses to the best of your knowledge. *

	Yes No
	Yes	No
1. Is the property or any adjoining property currently or in the past used for an industrial use?	Yes	No
2. Is the property or any adjoining property currently or in the past used as a gasoline station, motor vehicle repair facility, commercial printing factory, dry cleaners, photo developing lab, junkyard or landfill, or as a waste treatment storage, disposal, processing, or recycling facility?	Yes	No
3. Are there currently, or have previously been, any damaged or discarded automotive or industrial batteries, or pesticides, paints or other chemicals in individual containers or drums, stored on or used at this property?	Yes	No
4. Has fill dirt been brought onto the property which originated from a contaminated site or which is of unknown origin?	Yes	No
5. Do you have any reason to believe that the property or any adjoining property could contain any substance which may indicated an environmental concern?	Yes	No

I certify that the information provided above is true and correct to the best of my knowledge. I further agree to comply with all environmental laws, disclose any environmental information, allow The Bank the right to acquire any additional information about environmental concerns and grant The Bank indemnification for any environmental liability associated with the above referenced property. *

I agree

I DO NOT agree

PROPERTY 2: Please select the appropriate responses to the best of your knowledge. *

	Yes No
	Yes	No
1. Is the property or any adjoining property currently or in the past used for an industrial use?	Yes	No
2. Is the property or any adjoining property currently or in the past used as a gasoline station, motor vehicle repair facility, commercial printing factory, dry cleaners, photo developing lab, junkyard or landfill, or as a waste treatment storage, disposal, processing, or recycling facility?	Yes	No
3. Are there currently, or have previously been, any damaged or discarded automotive or industrial batteries, or pesticides, paints or other chemicals in individual containers or drums, stored on or used at this property?	Yes	No
4. Has fill dirt been brought onto the property which originated from a contaminated site or which is of unknown origin?	Yes	No
5. Do you have any reason to believe that the property or any adjoining property could contain any substance which may indicated an environmental concern?	Yes	No

Property 2: I certify that the information provided above is true and correct to the best of my knowledge. I further agree to comply with all environmental laws, disclose any environmental information, allow The Bank the right to acquire any additional information about environmental concerns and grant The Bank indemnification for any environmental liability associated with the above referenced property. *

I agree

I DO NOT agree

PROPERTY 3: Please select the appropriate responses to the best of your knowledge. *

	Yes No
	Yes	No
1. Is the property or any adjoining property currently or in the past used for an industrial use?	Yes	No
2. Is the property or any adjoining property currently or in the past used as a gasoline station, motor vehicle repair facility, commercial printing factory, dry cleaners, photo developing lab, junkyard or landfill, or as a waste treatment storage, disposal, processing, or recycling facility?	Yes	No
3. Are there currently, or have previously been, any damaged or discarded automotive or industrial batteries, or pesticides, paints or other chemicals in individual containers or drums, stored on or used at this property?	Yes	No
4. Has fill dirt been brought onto the property which originated from a contaminated site or which is of unknown origin?	Yes	No
5. Do you have any reason to believe that the property or any adjoining property could contain any substance which may indicated an environmental concern?	Yes	No

Property 3: I certify that the information provided above is true and correct to the best of my knowledge. I further agree to comply with all environmental laws, disclose any environmental information, allow The Bank the right to acquire any additional information about environmental concerns and grant The Bank indemnification for any environmental liability associated with the above referenced property. *

I agree

I DO NOT agree

PROPERTY 4: Please select the appropriate responses to the best of your knowledge. *

	Yes No
	Yes	No
1. Is the property or any adjoining property currently or in the past used for an industrial use?	Yes	No
2. Is the property or any adjoining property currently or in the past used as a gasoline station, motor vehicle repair facility, commercial printing factory, dry cleaners, photo developing lab, junkyard or landfill, or as a waste treatment storage, disposal, processing, or recycling facility?	Yes	No
3. Are there currently, or have previously been, any damaged or discarded automotive or industrial batteries, or pesticides, paints or other chemicals in individual containers or drums, stored on or used at this property?	Yes	No
4. Has fill dirt been brought onto the property which originated from a contaminated site or which is of unknown origin?	Yes	No
5. Do you have any reason to believe that the property or any adjoining property could contain any substance which may indicated an environmental concern?	Yes	No

Property 4: I certify that the information provided above is true and correct to the best of my knowledge. I further agree to comply with all environmental laws, disclose any environmental information, allow The Bank the right to acquire any additional information about environmental concerns and grant The Bank indemnification for any environmental liability associated with the above referenced property. *

I agree

I DO NOT agree

PROPERTY 5: Please select the appropriate responses to the best of your knowledge. *

	Yes No
	Yes	No
1. Is the property or any adjoining property currently or in the past used for an industrial use?	Yes	No
2. Is the property or any adjoining property currently or in the past used as a gasoline station, motor vehicle repair facility, commercial printing factory, dry cleaners, photo developing lab, junkyard or landfill, or as a waste treatment storage, disposal, processing, or recycling facility?	Yes	No
3. Are there currently, or have previously been, any damaged or discarded automotive or industrial batteries, or pesticides, paints or other chemicals in individual containers or drums, stored on or used at this property?	Yes	No
4. Has fill dirt been brought onto the property which originated from a contaminated site or which is of unknown origin?	Yes	No
5. Do you have any reason to believe that the property or any adjoining property could contain any substance which may indicated an environmental concern?	Yes	No

Property 5: I certify that the information provided above is true and correct to the best of my knowledge. I further agree to comply with all environmental laws, disclose any environmental information, allow The Bank the right to acquire any additional information about environmental concerns and grant The Bank indemnification for any environmental liability associated with the above referenced property. *

I agree

I DO NOT agree

FINANCIAL AND INCOME STATEMENT SUMMARY

Total Assets: $

Total Annual Income: $

Total Liabilities: $

Total Annual Expenses: $

Net Worth: $

Net Annual Cash Flow: $

*Alimony, Child Support or Separate Maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

CERTIFICATION OF BENEFICIAL OWNER(S)

Person opening an account on behalf of a legal entity must provide the following information:

A. Name and Title of Natural Person Opening Account: *

B. Name, Type, and Address of Legal Entity for which the Account is being opened: *

C. The following information for each individual, if any, who directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25% or more of the equity interests of the legal entity listed above:

If checked, Beneficial Owner listing requirement is not applicable.

	Name	Date of Birth	Address (residential or business)	SSN (US Persons)	SSN, Passport # & Country of Issuance, or other ID #
1	Name	Date of Birth	Address (residential or business)	SSN (US Persons)	SSN, Passport # & Country of Issuance, or other ID #
2	Name	Date of Birth	Address (residential or business)	SSN (US Persons)	SSN, Passport # & Country of Issuance, or other ID #
3	Name	Date of Birth	Address (residential or business)	SSN (US Persons)	SSN, Passport # & Country of Issuance, or other ID #
4	Name	Date of Birth	Address (residential or business)	SSN (US Persons)	SSN, Passport # & Country of Issuance, or other ID #

D. The following information for one individual with significant responsibility for managing the legal entity listed above, such as:

An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, Treasurer); or

Any other individual who regularly performs similar functions.

If appropriate, an individual listed under section (c) above may also be listed in this section (d)

	Name	Date of Birth	Address (residential or business)	SSN (US Persons)	SSN, Passport # & Country of Issuance, or other ID #
1	Name	Date of Birth	Address (residential or business)	SSN (US Persons)	SSN, Passport # & Country of Issuance, or other ID #

I certify, to the best of my knowledge, that the information provided above is complete and correct. We agree to notify the Bank of any change in such information should it occur. *

AUTHORIZATIONS & DISCLOSURES

ELECTRONIC DISCLOSURE AUTHORIZATION

The Electronic Disclosure and Consent contains important information that you are entitled to receive before you consent to transact business with us electronically. Please read this notice and print or download a copy for your files.

Borrower

I have read and agree to accept account disclosures online and affirmatively consent to receive the required disclosures in electronic form, including disclosures required by the Truth in Lending Act, Real Estate Settlement Procedures Act and Equal Credit Opportunity Act. Paper copies will be provided for certain real estate related transactions after your loan application is received. I also agree to receive communications regarding the status of my application electronically via the email address provided with the online application. *

I AGREE to the Electronic Disclosure Authorization

I DO NOT AGREE to the Electronic Disclosure Authorization

Co-Borrower

I have read and agree to accept account disclosures online and affirmatively consent to receive the required disclosures in electronic form, including disclosures required by the Truth in Lending Act, Real Estate Settlement Procedures Act and Equal Credit Opportunity Act. Paper copies will be provided for certain real estate related transactions after your loan application is received. I also agree to receive communications regarding the status of my application electronically via the email address provided with the online application. *

I AGREE to the Electronic Disclosure Authorization

I DO NOT AGREE to the Electronic Disclosure Authorization

CREDIT CHECK AUTHORIZATION

Borrower

I hereby grant permission for you to obtain all information deemed necessary to process your loan application. This information includes, but is not limited to, your past and present employment status, your deposit accounts, your past and present consumer credit record, your mortgage record and/or your rental record. *

I AGREE to the Credit Check Authorization

I DO NOT AGREE to the Credit Check Authorization

Co-Borrower

I hereby grant permission for you to obtain all information deemed necessary to process your loan application. This information includes, but is not limited to, your past and present employment status, your deposit accounts, your past and present consumer credit record, your mortgage record and/or your rental record. *

I AGREE to the Credit Check Authorization

I DO NOT AGREE to the Credit Check Authorization

PATRIOT ACT

Borrower

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: As part of applying for your loan, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. *

I AGREE to the Patriot Act

I DO NOT AGREE to the Patriot Act

Co-Borrower

To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: As part of applying for your loan, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. *

I AGREE to the Patriot Act

I DO NOT AGREE to the Patriot Act

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

Borrower

Ethnicity (check one or more) *

Hispanic/Latino

Not Hispanic/Latino

I do not wish to provide

Hispanic or Latino *

Mexican

Puerto Rican

Cuban

Other Hispanic or Latino

Other Hispanic or Latino - Print origin, for example: Argentinean, Columbian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on *

Race (check one or more) *

Asian *

Native Hawaiian or Other Pacific Islander *

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

American Indian or Alaskan Native - Print name of enrolled or principal tribe: *

Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on *

Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on *

Sex *

Female

Male

I do not wish to provide

Co-Borrower

Ethnicity (check one or more) *

Hispanic/Latino

Not Hispanic/Latino

I do not wish to provide

Hispanic or Latino *

Mexican

Puerto Rican

Cuban

Other Hispanic or Latino

Other Hispanic or Latino - Print origin, for example: Argentinean, Columbian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on *

Race (check one or more) *

Asian *

Native Hawaiian or Other Pacific Islander *

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

American Indian or Alaskan Native - Print name of enrolled or principal tribe: *

Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on *

Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on *

Sex *

Female

Male

I do not wish to provide

NOTICE OF RIGHT TO RECEIVE A COPY OF APPRAISAL

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close.

You can pay for an additional appraisal for your own use at your own cost.

Borrower *

I acknowledge receipt of this Notice of Right to Receive a Copy of Appraisal

Co-Borrower *

I acknowledge receipt of this Notice of Right to Receive a Copy of Appraisal

ACKNOWLEDGMENT AND AGREEMENT

I/We hereby apply for the loan or credit described in this application on behalf of the applicant business. I/We certify that I/we made no misrepresentation in this loan application or in any related documents, that all information is true and complete, and that I/we did not omit any important information. I/We agree that any property securing the loan or credit will not be used for any illegal or restricted purpose. Lender is authorized to verify with other parties and to make any investigation of my/our credit, either directly or through any agency employed by teh Lender for that purpose. Lender may disclose to any other interested parties information as to Lender's experiences or transaction with my/our account. I/We understand that Lender will retain this application and any other credit information Lender receives, even if no loan or credit is granted. These representations and authorizations extend not only to Lender, but also to any insurer of the loan and to any investor to whom Lender may sell all or any part of the loan. I/We further authorize Lender to provide any such insurer or investor any information and documentation that they may request with respect to my/our application, credit or loan.

Borrower's Name *

Co-Borrower's Name *

Preferred Branch & Loan Officer

Branch Location *

Loan Originator *

How did you learn about us? *

Existing Customer *

Your application request will be submitted into a secure, encrypted website in order to protect your confidential information.