Download - ValueBank Texas Commercial Loan Application
ValueBank TexasCommercial Loan Application
Business Information:
Business Name ___________________________________________________________________________________________
Full Street Address ________________________________________________________________________________________
City_____________________________________ County __________________________ State _______ Zip________
Primary Contact ___________________________________ Phone (___)_______________ Fax (___)_________________
Secondary Contact _________________________________ Phone (___)_______________ Fax (___)_________________
Type of Business __________________________________________________________________________________________
________________________________________________________________________________________________________
Type of Entity: Corporation Partnership LLC Sole Proprietorship Other _______________________
Date Business established _____/_____/_______ Tax I.D. _______________________________________________
Business e-mail address _________________________________________
Business Ownership: (Attach additional pages if necessary)
Name ______________________________________________ Title ____________________ % of Ownership _____
Name ______________________________________________ Title ____________________ % of Ownership _____
Name ______________________________________________ Title ____________________ % of Ownership _____
Affiliate Businesses, if applicable: (Attach additional pages if necessary)
Name ____________________________________ Address ______________________________________________________
Type of Business ____________________________________________________________________ Tax I.D. ______________
Existing Business Locations: (Attach additional pages if necessary)
Address _______________________________________________ City_____________________ State ____ Zip_____
Rent Own Square Feet ______________________ Monthly Payment _________________________
Address _______________________________________________ City_____________________ State ____ Zip_____
Rent Own Square Feet ______________________ Monthly Payment _________________________
References: (Attach additional pages if necessary)
Bank of Business Account ______________________________ Acct. Officer _______________ Phone ___________
Accountant Name _______________________________________________________________ Phone ___________________
Attorney Name _________________________________________________________________ Phone ___________________
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Insurance Agent Name ___________________________________________________________ Phone ___________________
Does your company maintain key person life insurance on any owner or officer? Yes No
Life Insurance Agent _____________________________________________________________ Phone ___________________
Name of Insured ________________________________________________________________ Amount $ _________________
Life Insurance Company ____________________________________________ Beneficiary ______________________________
Trade References: (Attach additional pages if necessary)
Contact Person _________________________________________________________________ Phone ___________________
Contact Person _________________________________________________________________ Phone ___________________
Employee Information:
Number of current employees ______: Estimated number of new employees within next two years as a result of this loan _____.
Number of current employees at affiliated businesses _______ (if applicable)
Key Employees: (Attach additional pages if necessary)
Name Title Responsibilities Years withCompany
Years in Industry
Additional Information (Please answer the following questions and provide additional information where necessary):
Have you or any officer of your company ever been involved in bankruptcy or insolvency proceedings? Yes No (If yes, please provide details)
Are you or your business / affiliate involved in any pending lawsuits? Yes No (If yes, please provide details)
Does the business owe any taxes for years prior to the current year? Yes No (If yes, please provide details)
Is the business an endorser, guarantor, or co-maker for obligations not listed on its financial statements? Yes No (If yes, please provide details)
Does your business use or store any hazardous / toxic materials or produce hazardous / toxic materials? Yes No (If yes, please provide details)
Do you or your spouse or any member of your household, or anyone who owns, manages, or directs your business or their spouses or members of their households work for the Small Business Administration, Small Business Advisory Council, SCORE or ACE, any Federal Agency, or the participating lender? Yes No (If yes, please provide details)
Does your business, its owners or majority stockholders own or have a controlling interest in other businesses? Yes No (If yes, please provide details, including their names, relationship with your company, and ownership)
Do you buy from, sell to, or use the services of any concern in which someone in your company has a significant financial interest? Yes No (If yes, please provide details, including their names, relationship with your company, and ownership)
Does your business currently export, or will it start exporting, pursuant to this loan (if approved)? Yes No
If Yes, what is your estimate of the total annual export sales this loan would support $_____________________________
Would you like information on exporting? Yes No
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Previous Government Financing, Loans (incl. Student Loans), Debts, and/or Other Obligations: (Attach additional pages if necessary)
If you or any principals or affiliates have ever requested Government Financing complete the following:
Name of Entity Original Amount
of Loan Date of Request Approved or
Declined Balance Current or Past Due
Assistance with preparing this Information: (Attach additional pages if necessary)
List the name(s) and occupations of anyone who you paid or agreed to pay to assist with the preparation of this application:
Name and Occupation Address Total Fees Paid Fees Due
Description of Your Business: (Please attach additional page(s) as needed or substitute with your business plan)
History of your business: ____________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Types of products and/or services (attach any catalogs, brochures, etc.):_______________________________________________
________________________________________________________________________________________________________
History of the business:______________________________________________________________________________________
________________________________________________________________________________________________________
Industry outlook: ___________________________________________________________________________________________
________________________________________________________________________________________________________
How will this loan benefit your business? ________________________________________________________________________
________________________________________________________________________________________________________
Geographic market area where business operates: _______________________________________________________________
________________________________________________________________________________________________________
List key customers: _________________________________________________________________________________________
________________________________________________________________________________________________________
List key competitors: ________________________________________________________________________________________
________________________________________________________________________________________________________
Future Plans: _____________________________________________________________________________________________
________________________________________________________________________________________________________
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Project Information: (Attach additional pages if necessary)
Project Description (Explain what you want to do; attach additional pages, if necessary): __________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Street Address of Project ____________________________________________________________________________________
City _____________________________________________ State ________ Zip __________ County ___________________
Total Project Costs and Uses of Funds: Collateral Offered: If Mortgaged, Present Market Value Present Loan Balance
Real Estate Acquisition $ _____________ Land (vacant) $ _____________ $ _____________
New Construction/Expansion/Repair $ _____________ Land & Buildings $ _____________ $ _____________
Acquisition of Machinery and Equipment $ _____________ Machinery/Equip. $ _____________ $ _____________
Acquisition of Existing Business $ _____________ Furniture $ _____________ $ _____________
Inventory Purchase $ _____________ Leasehold Impr. $ _____________ $ _____________
Working Capital $ _____________ Accounts Rec. $ _____________ $ _____________
Payoff Bank Loan (Copy of notes required) $ _____________ Inventory $ _____________ $ _____________
Other Debt Payment (Details attached) $ _____________ Other $ _____________ $ _____________
All Other ___________________________ $ _____________ Other $ _____________ $ _____________
All Other ___________________________ $ _____________ Other $ _____________ $ _____________
Total Project Costs $ _____________ Total $ _____________ $ _____________
Less: Borrower’s Injection / Down Payment $ _____________
Loan Amount $ _____________; and, Repayment Terms in Years ___________________________ - or - monthly payment amount preferred/requested.
Source of Applicant’s, Injection, and/or Down Payment _________________________________________________
If purchasing real property, how will the property be owned? (i.e. individually, partnership, corporation, trust, etc.) _______________
________________________________________________________________________________________________________ (Please provide appropriate documentation (i.e. Sales/Purchase Contract, Partnership Agreement, Articles of Incorporation, Trust Agreement, etc.)
Please attach copies of bids, purchase orders, invoices, estimates, cost budgets, contracts, etc. for the total project costs above.
I / We certify that the above information and information contained in attachments / exhibits is true and accurate to the best of my / our knowledge.
Name of Applicant (s) ____________________________________________________________________________
Authorized Signature __________________________________________________ Date __________________
Name of Applicant (s) ____________________________________________________________________________
Authorized Signature __________________________________________________ Date __________________
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P. O. Box 4956Corpus Christi, Texas 78469
361-888-4451
AUTHORIZATION TO INVESTIGATE CHARACTER & CREDIT HISTORY
The information contained in this statement, including any supplements, is provided to induce ValueBank Texas, its affiliate(s), agent(s), associate(s), participant(s), or other lender(s), collaborator(s), or colleague(s) (hereinafter referred to as VBT) to extend, or consider extending, or continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that VBT is relying on the information provided herein and herewith in deciding to grant or continue credit or to accept a guarantee thereof. Each of the undersigned represents, warrants, and certifies that the information provided herein and herewith is true, correct, and complete. Each of the undersigned agrees to notify VBT immediately and in writing of any change in the information and of any material adverse change in the financial condition or the ability to perform obligations of the undersigned. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. VBT or its agents are authorized to make all inquiries VBT deems necessary to verify the accuracy of the information contained herein and herewith and to determine the credit-worthiness of the undersigned. The undersigned agree to reimburse VBT for any and all expenses incurred in the consideration, making, and/or administration of any and all loans or other extensions of credit related hereto. The undersigned authorize any consumer, commercial, or credit reporting agency, creditor, employer, reference, or any other person or entity to give VBT, its agents, associates, etc., any information it may have on the undersigned. The undersigned further authorizes VBT, its agents, associates, etc., to share all information. This statement and any other information that the undersigned furnish to VBT or that VBT obtains hereinafter related shall be VBT property whether credit is extended or not.
FULL NAME: _____________________________________________________________________
ADDRESS: _____________________________________________________________________
CITY: ________________________________ STATE: ______________ ZIP:___________
SOCIAL SECURITY # ________________________________ DATE OF BIRTH:______________________
SIGNATURE: _____________________________________________________________________
DATE: ________________________________ PHONE # : __________________________
PLEASE COMPLETE FOR JOINT REQUESTS:
FULL NAME: _____________________________________________________________________
ADDRESS: _____________________________________________________________________
CITY: ________________________________ STATE: ______________ ZIP: ___________
SOCIAL SECURITY # ________________________________ DATE OF BIRTH:______________________
SIGNATURE: _____________________________________________________________________
DATE: ________________________________ PHONE # : __________________________
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Customer/Applicant Identification Form
Applicant
___________________________________________________________________________________________________________Name
___________________________________________________________________________________________________________Address
___________________________________________________________________________________________________________(Physical Address, or directions if above is a P.O. Box #)
___________________________________________________________________________________________________________City, State, Zip Code
___________________________________________________________________________________________________________Email Address
_______________________________________Date of Birth
_______________________________________ _______________________________________ Social Security # or TIN # SSN Issue Date
_______________________________________ _______________________________________ ID# ID Issuer (State)
_______________________________________ _______________________________________ ID Issue Date ID Expiration Date
Veri�ed by:
_____________________Initials
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Customer/Applicant Identification Form
Co-Applicant
___________________________________________________________________________________________________________Name
___________________________________________________________________________________________________________Address
___________________________________________________________________________________________________________(Physical Address, or directions if above is a P.O. Box #)
___________________________________________________________________________________________________________City, State, Zip Code
___________________________________________________________________________________________________________Email Address
_______________________________________Date of Birth
_______________________________________ _______________________________________ Social Security # or TIN # SSN Issue Date
_______________________________________ _______________________________________ ID# ID Issuer (State)
_______________________________________ _______________________________________ ID Issue Date ID Expiration Date
Veri�ed by:
_____________________Initials
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Commercial Credit Denial Notice
Commercial Credit Denial Notice To �e Commercial Applicant:
If your gross revenues were 1,000,000.00 or less in your previous �scal year, or you are requesting trade credit, a factoring agreement, or similar types of business credit in the Commercial Loan Application, and if you application for business credit is denied, you have the right to a wri�en statement of the speci�c reasons for the denial. To obtain the statement please contact...
VALUEBANK TEXAS3649 LEOPARD STREET
CORPUS CHRISTI, TX 78408
within 60 days from the date you are noti�ed of our decision. We will send you a wri�en statement of reason for the denial within 30 days of receiving your request for the statement. �e notice that follows describes additional protections extended to you.
EQUAL CREDIT OPPORTUNITY NOTICE: �e federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, martial status, age (providing the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance program, or because applicant has in good faith exercised any right under the Consumer Credit Protection Act. �e federal agency that administers compliance with this law concerning this creditor is:
FEDE�L DEPOSIT INSU�NCE COMPANY1100 WALNUT STREET, SUITE 2100
�NSAS CITY, MO 641061(800)209-7459
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Other Important Information
ValueBank Texas is chartered under the laws of the State of Texas and by state law is subject to regulatory oversight by the Texas Department of Banking. Any consumer wishing to �le a complaint against ValueBank Texas should contact the Texas Department of Banking.
ValueBank Texas also engages in the money transmission and currency exchange business as an authorized delegate of American Express. MoneyGram and Currency Exchange International under Chapter 151 of the Texas Finance Code. If you have a complaint, first contact the consumer assistance division of MoneyGram at (800)-549-3590 or Currency Exchange International at, (888)-998-3948 if you still have an unresolved complaint regarding the company’s money transmission or currency exchange activity, please direct your complaint to Texas Department of Banking.
Consumers/customers may �le complaints with the Texas Department of Banking by contacting the Department through one of the means indicated below:
In Person or U.S. Mail to....
Telephone Number............. Fax Number.......................... E-Mail Address.................... Website..................................
Texas Department of BankingAttention: Consumer Assistnance Activities2601 North Lamar Boulevard (877)276-5554 (toll free)(512)[email protected] www.dob.texas.gov
�ank you very much for banking with ValueBank Texas. We are proud to have you as a customer and you may rest assured that we are doing everything possible to protect the privacy of the �nancial information you have entrusted us with.
Other Important Information
VBT Commercial Loan Application (07/2015/rp)9
Privacy Disclosure
WHAT DOES VALUEBANK TEXAS DO WITH YOUR PERSONAL INFORMATION
Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share and protect your personal information. Please read this notice carefully to understand what we do.
�e types of personal information we collect and share depends on the product or service you have with us. �is information can include:
• Social Security Number and Income• Account Balances and Payment History• Credit History and Credit Scores
When you are no longer our customer, we continue to share your information as described in this notice.
All �nancial companies need to share customers’ personal information to run their everyday business. In the section below, we list the reason �nancial companies can share their customer’s personal information: the reasons ValueBank Texas chooses to share; and whether you can limit this sharing.
FACTS
Why?
What?
How?
Questions? Call (361)888-4451 or go to valuebanktexas.com
Reasons we can share your personal information Does ValueBank Texas share? Can you limit this sharing?For our everyday business purposes - such as to process your transactions, maintain your account(s), respond to court orders and legal investigations
Four our marketing purposes - to o�er our products and services to you
For joint marketing with other �nancial companies
For our a�liates’ everday business purposes - information about your transactions and experiences
For our a�liates’ everyday business purposes - information about your credit worthiness
For our a�liates to market to you
For non-a�liates to market to you
Yes No
Yes No
No We Do Not share
No We Do Not share
No We Do Not share
No We Do Not share
No We Do Not share
What We Do
Who We Are
Who is providing this notice? ValueBank Texas
How does ValueBank Texas protect my personal information?
How does ValueBank Texas collect my personal information?
Why can’t I limit all sharing?
To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. �ese measures include computer safeguards and secured �les and buildings.
We collect your personal information, for example, when you• Open an account• Pay your bills or apply for a loan• Use your debit or credit card
Federal law gives you the right to limit only• Sharing for a�liates’ everyday business purposes - information about
your credit worthiness• A�liates from using your information to market to you• Sharing for non-a�liates to market to you
State laws and individual companies may give you additional rights to limit sharing
A�liates Companies related by common ownership or control. �ey can be �nancial or non-�nancial companies
Non-A�liates Companies not related by common ownership or control. �ey can be �nancial or non-�nancial companies
Joint Marketing A formal agreement between non-a�liated �nancial companies that together market �nancial products or services to you
De�nitions
10
Additional Needed Documentation, Checklist: (Please supply the following information, as applicable) (All information should be signed & dated)
Business Information:
Business Tax Returns for the past three years.
Interim Financial Statements (P&L and Balance Sheet) within 45 days of application (form attached).
Listing & Aging of Accounts Receivable and Accounts Payable dated the same date as the interim financial statements.
Business Debt Schedule dated the same date as the interim financial statements (form attached).
Projections of Income & Expenses for next 3 years, if loan approved, with supporting assumptions (forms attached).
Legal Entity Documents: • Articles of Incorporation, Certificate of Incorporation, and By-laws for corporations.• Articles of Organization, Articles of Formation, and Operating Agreement for LLCs.• Partnership Agreement for partnerships.
Copies of Assumed Name Certificate(s) and Business License(s).
Franchise Agreement and FTC Disclosure Document for licensed franchises.
Copy of existing or new leases to be entered.
Affiliate Business Information:
Business Tax Returns for the past three years (signed and dated).
Interim Financial Statements (P&L and Balance Sheet) within 45 days of application (form attached).
Business Debt Schedule dated the same as the interim financial statement (form attached).
Legal Entity Documents: • Articles of Incorporation, Certificate of Incorporation, and By-laws for corporations.• Articles of Organization and Operating Agreement for LLCs.• Partnership Agreement for partnerships.
Assumed Name Certificate and Business License.
Franchise Agreement and FTC Disclosure Document (if applicable).
Personal Information: (for each owner)
Personal Tax Returns for the past three years.
Personal Resume for each owner / shareholder / guarantor. (form(s) attached).
Personal Financial Statement for each owner / shareholder / guarantor. (form(s) attached).
Collateral Information:
Real estate Sale/Purchase Agreement, Title Company Settlement Statement, and/or Deed.
Asset purchase agreement & copy of bill of sale for business acquisition.
Construction cost-budget and/or bids.
Equipment cost-budget and/or bids.
Existing environmental studies, appraisals, and surveys on the property.
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PERSONAL RESUME/INFORMATION (Please complete for each owner of the business)
Name _______________________________________________________ Social Security No. ______________________ First Middle Initial Last
Home Phone ___________________ Business Phone __________________ Cell Phone ______________________
Address _________________________________________ City______________________ State _______ Zip_________
Immediate past address _____________________________ City______________________ State _______ Zip_________
From ________/________ To _______/________ e-mail address _________________________________________
Driver’s License / Passport # ___________________________ Issuer (State or Country) __________________________
Issue Date ___________ Exp. Date _________ Verified Initials ___________ For Bank Use Only
Spouse’s name* ___________________________________________________________________________________________ First Middle Initial Last
*You are not required to provide information regarding a spouse unless the spouse is a co-applicant for the loan, you are relying on the spouse’s income for repayment of the loan, you reside in a community property state, the proposed business is located in such a state, or you are relying on alimony, child support, or separate maintenance as a source of repayment.
EDUCATION: (High School, College or Technical Training)
Name and Location Dates Attended Major Degree / Certificate
__________________________ _________________________ ___________________ _________________________
__________________________ _________________________ ___________________ _________________________
__________________________ _________________________ ___________________ _________________________
__________________________ _________________________ ___________________ _________________________
WORK EXPERIENCE: (List chronologically beginning with present employment)
Name of company _________________________________________________________________________________________
Address _________________________________________ City______________________ State _______ Zip__________
From ________/________ To _______/________ Title _________________________________________________________
Job Description ___________________________________________________________________________________________
Name of company _________________________________________________________________________________________
Address _________________________________________ City______________________ State _______ Zip__________
From ________/________ To _______/________ Title _________________________________________________________
Job Description ___________________________________________________________________________________________
Name of company _________________________________________________________________________________________
Address _________________________________________ City______________________ State _______ Zip__________
From ________/________ To _______/________ Title _________________________________________________________
Job Description ___________________________________________________________________________________________
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PERSONAL FINANCIAL STATEMENT
As of ,
Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.
Name Business Phone
Residence Address Residence Phone
City, State, & Zip Code
Business Name of Applicant/Borrower
ASSETS
Cash on hand & in Banks Savings Accounts IRA or Other Retirement Account Accounts & Notes Receivable Life Insurance-Cash Surrender Value Only
(Complete Section 8)
Stocks and Bonds (Describe in Section 3)
Real Estate (Describe in Section 4)
Automobile-Present Value Other Personal Property
(Describe in Section 5)
Other Assets (Describe in Section 5)
Total
Section 1. Source of Income
Salary
Net Investment Income
Real Estate Income
Other Income (Describe below)*
Description of Other Income in Section 1.
(Omit Cents) LIABILITIES (Omit Cents)
$ Accounts Payable $ $ Notes Payable to Banks and Others $ $ (Describe in Section 2) $ Installment Account (Auto) $ $ Mo. Payments $
Installment Account (Other) $ $ Mo. Payments $
Loan on Life Insurance $ $ Mortgages on Real Estate $
(Describe in Section 4) $ Unpaid Taxes $ $ (Describe in Section 6)
Other Liabilities $ $ (Describe in Section 7)
Total Liabilities $
Net Worth $ $ Total $
Contingent Liabilities
$ As Endorser or Co-Maker $ $ Legal Claims & Judgments $ $ Provision for Federal Income Tax $ $ Other Special Debt $
*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.
(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)Section 2. Notes Payable to Banks and Others.
Original Current Payment Frequency How Secured or EndorsedName and Address of Noteholder(s) Balance Balance Amount (monthly,etc.) Type of Collateral
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Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed).
Number of Shares Name of Securities Cost Market Value Date of Total ValueQuotation/Exchange Quotation/Exchange
Section 4. Real Estate Owned. (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed.)
Property A Property B Property C
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name &Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment per Month/Year
Status of Mortgage
(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, termsSection 5. Other Personal Property and Other Assets. of payment and if delinquent, describe delinquency)
Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)
Section 7. Other Liabilities. (Describe in detail.)
Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)
I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001).
Signature: Date: Social Security Number:
Signature: Date: Social Security Number:
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Cash Flow Statement
STATEMENT DATE
CASH FLOW FOR PERSONAL FINANCIAL STATEMENTINCOME Monthly Year Projected Next Yr.
Salary/WagesBonus/CommissionsDividends/InterestTrust IncomeRentals/R.E. Income (net exp.)RoyaltiesCapital GainsEquipment LeasesGifts/InheritancesLegal/Insurance SettlementsTax RefundSpouse IncomeOther
TOTAL INFLOWS
EXPENSESHousing (Mortgage or Rent)Auto PaymentOther Loan PaymentsCredit Card PaymentsInsurance Payments (Car, Home, Life, Health)Property Taxes (if not included in mortgage)Electric/Gas Bill/WaterPhone BillGasolineGroceriesChild SupportChild CareOther Living Expenses
TOTAL OUTFLOWS (Expenses)NET CASH FLOW (Income - Expenses)
-$ -$
-$ -$
-$ -$
-$ -$ -$
$ $ $
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DATE SIGNATURE
DATE CO-APPLICANT'S SIGNATURE (if you are requesting joint credit)
VALUEBANK TEXAS (361) 888-4451 (361) 866-7791 Fax www.valuebanktexas.com
P.O. BOX 4956, CORPUS CHRISTI, TEXAS 78469-4956
The information contained in this statement, including any supplements, is provided to induce ValueBank Texas, its affiliate(s), agent(s), associate(s), participant(s), or other lender(s), collaborator(s), or colleague(s) (hereinafter referred to as VBT) to extend, or consider extending, or continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that VBT is relying on the information provided herein and herewith in deciding to grant or continue credit or to accept a guarantee thereof. Each of the undersigned represents, warrants, and certifies that the information provided herein and herewith is true, correct, and complete. Each of the undersigned agrees to notify VBT immediately and in writing of any change in the information and of any material adverse change in the financial condition or the ability to perform obligations of the undersigned. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. VBT or its agents are authorized to make all inquiries VBT deems necessary to verify the accuracy of the information contained herein and herewith and to determine the credit-worthiness of the undersigned. The undersigned agree to reimburse VBT for any and all expenses incurred in the consideration, making, and/or administration of any and all loans or other extensions of credit related hereto. The undersigned authorize any consumer, commercial, or credit reporting agency, creditor, employer, reference, or any other person or entity to give VBT, its agents, associates, etc., any information it may have on the undersigned. The undersigned further authorizes VBT, its agents, associates, etc., to share all information. This statement and any other information that the undersigned furnish to VBT or that VBT obtains hereinafter related shall be VBT property whether credit is extended or not.
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" PROJECTED " BUSINESS INCOME & EXPENSE STATEMENT (P&L)
(Assume 12 month periods, if requested loan is obtained)
BUSINESS NAME:
YEAR: 1 YEAR: 2 YEAR: 3
INCOME: $ $ $Gross Revenue: Less: Returns & AllowancesNet Revenue: $ $ - Less: Cost of Goods Sold:Gross Profit: $ $ - Other Income:Total Gross Income: $ $ -
EXPENSES: $ $ $AdvertisingCar & Truck ExpenseCommissions & FeesContract LaborDepreciationInsuranceInterest ExpenseLegal & ProfessionalLicenses & PermitsOffice ExpensePostageRentRepairs & MaintenanceSuppliesTelephoneTravel & EntertainmentUtilities (Electric, Water, Gas, Garbage)Wages (Employee Payroll)Payroll TaxesProperty Taxes (Real Estate & Property)Other Expenses:Total Expenses: $ $ -
NET PROFIT: $ $ -
Estimated Income Taxes:Owners/Officers Withdrawal (W/D)
NET PROFIT after W/D & Inc Taxes: $ $ -$
Authorized Signature: _______________________________________________ Date: _______________
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ASSUMPTIONS FOR PROJECTIONS
BUSINESS NAME
Please use this page to explain the assumptions used to generate the three year projection figures. Outline the specific reasons as to why the projected figures differ from previous years for Revenues, Cost of Goods Sold, Other Income, and Operating Expenses. Use the comments section for additional information.
EXPLANATIONS:
Revenues:
Cost of Goods Sold:
Other Income:
Operating Expenses:
Comments:
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SCHEDULE OF BUSINESS DEBT & OTHER FIXED OBLIGATIONS (SCHEDULE OF NOTES, CONTRACTS, LEASES, ETC PAYABLE)
Please furnish information on all mortgage debt, notes, installment debt, contracts, leases, and other fixed obligations. This schedule should be as of the same date as the interim financial statement balance sheet. “Total Present Balance” should equal the debt shown on the interim financial statement balance sheet. Under status, please indicate whether the loan / lease / or contract is current or delinquent. (Use additional pages, if needed)
Creditor Name and Address Account Number
Original Date
Maturity Date
Original Amount
Present Loan Balance
Int. Rate
Payment Frequency
No. of Payment
Remaining Payment Amount Collateral Status
Total Present Balance
$ Total Monthly Payment $
Authorized Signature _________________________________________ Date ____________________
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SCHEDULE OF MACHINERY, EQUIPMENT, FURNITURE, & OTHER NON-REAL ESTATE ITEMS
Please furnish information on all machinery, equipment, furniture, and other non-real estate items. (Use additional pages, if needed)
Description, Make or Manufacturer Model Year
Serial Number
(for items valued $500+)
Date Acquired
Original Cost
Present Value
Current Loan Balance
Lien Holder
Authorized Signature _________________________________________ Date ____________________
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