Vision Mortgage Company, Ltd.
Key Advisors
Section 2 of 11
Small Business Loan Request

Please print this form. After completion, submit it to your Vision Mortgage Company loan officer.

Business Services and Advisors

  Bank of Business Account Name ________________________________ Account # _________________  
  Account Officer _________________________________ Telephone _______________________  
  Branch Address ________________________________________________________________  
  CPA Firm Name _______________________________________________________________________  
  Contact _______________________________________ Telephone _______________________  
  Address ______________________________________________________________________  
  Law Firm Name _______________________________________________________________________  
  Contact _______________________________________ Telephone _______________________  
  Address _______________________________________________________________________  
  Business Insurance Broker Company Name __________________________________________________  
  Broker/Agent ___________________________________Telephone _______________________  
  Address ______________________________________________________________________  
  Personal Insurance Broker Company Name ___________________________________________________  
  Broker/Agent ___________________________________Telephone _______________________  
  Address ______________________________________________________________________  
  Commercial Real Estate Broker Company Name _______________________________________________  
  Broker/Agent ___________________________________Telephone _______________________  
  Address ______________________________________________________________________  

Yes No . . Do you buy from, sell to, or use the services of any concern in which an officer, director, key manager or owner of 20% or more of this company has a significant financial interest? If so, please provide details.

Yes No . . Have you or any officers of the company ever been involved in bankruptcy or insolvency proceedings? If so, please provide details.

Yes No . . Are you or your business involved in any pending lawsuits? If so, please provide details.

Yes No . . Are any officers, directors, key managers or owners of 20% or more of the company presently under indictment, or on parole or probation? If so, please provide details.

Yes No . . Have any officers, directors, key managers or owners of 20% or more of the company ever been charged with or arrested for any criminal offense other than a minor vehicle violation? If so, please provide details.

Yes No . . Have any officers, directors, key managers or owners of 20% or more of the company ever been convicted of any criminal offense other than a minor vehicle violation? If so, please provide details.

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