| Loan Request |
| Section 1 of 11 |
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| Small Business Loan Request |
| Please print this form. After completion, submit it to your Vision Mortgage Company loan officer. |
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Applicant Company
| Principal's Name
_______________________________________ Title
____________________________ Second Contact Name ___________________________________ Title ___________________________ Company Name _______________________________________________________________________ Address _________________________________________ Telephone (business) ___________________ Telephone (home) _________________ Facsimile ___________________ E-Mail: ___________________ City ________________________ County ____________________ State __________ Zip _____________ Type of Entity: Number of Employees: Existing _______________ After Loan _______________ Date Business Established: ______________________ Tax ID# ____________________________ |
Ownership and Management of Applicant Company
| List below all owners,
co-owners, and all stockholders of the company. (100%
ownership should be indicated.) Name ____________________________________ Title ________________ % of Ownership __________ Name ____________________________________ Title ________________ % of Ownership __________ Name ____________________________________ Title ________________ % of Ownership __________ Name ____________________________________ Title ________________ % of Ownership __________ |
Affiliates
| List below all business
concerns in which the applicant company or any of the
individuals listed in the ownership section above have
ownership. Company Name __________________________ Owner _________________ % of Ownership _________ Company Name __________________________ Owner _________________ % of Ownership _________ Company Name __________________________ Owner _________________ % of Ownership _________ Company Name __________________________ Owner _________________ % of Ownership _________ |
Use of Loan Proceeds
| Real estate acquisition | $__________________ |
| New building construction | $__________________ |
| Building/Leasehold improvements or repairs | $__________________ |
| Acquisition of machinery or equipment | $__________________ |
| Inventory purchase | $__________________ |
| Acquisition of existing business | $__________________ |
| Debt refinancing | $__________________ |
| Payment of accounts payable | $__________________ |
| Working capital | $__________________ |
| Other | $__________________ |
| Total Project Costs | $__________________ |
| Less: Down Payment | $__________________ |
| Requested Loan Amount | $__________________ |
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