Spreadsheet: 554a5b2d-1e0e-47b0-a371-57f41f6b2563
Sheet: Sheet1

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STOREFRONT IMPROVEMENT LOAN APPLICATION
(Additional financial information will be required for loans over $50,000)
[NAME] |  |  |  |  |  |  | Amount Requested
Street Address |  |  |  |  |  |  | Organization Type
Mailing Address |  |  |  |  |  |  | Business Phone
Business Tax I.D. |  |  |  |  |  |  | E-Mail Address
MANAGEMENT / OWNERSHIP (Individuals with 10% or greater ownership are required to guarantee)
Name and Title |  |  |  |  | Name and Title
Social Security Number |  |  |  |  | Social Security Number
Ownership Percentage |  |  |  |  | Ownership Percentage
Annual Personal Income |  |  |  |  | Annual Personal Income
 | Applicant applying for this loan
 | Individually, without a co-signer or guaranty of a relative or other person (s) or entity.
 | Jointly, with the co-signature or guaranty of one or more persons or entities (including existing guarantors).
 | Account Type
 | Checking
 | Savings
 | Certificate of Deposit
 | Bank
 | Columbia Community Bank
 | Bank of America
 | Key Bank
 | Washington Mutual
 | Wells Fargo
 | Pledged for a Loan
 | No
 | Yes
 | Year
 | 2003
 | 2004
 | 2005
 | [NAME]
 | Married
 | Separated
 | Unmarried (single, divorced, widowed)
 | Financial Condition as of
 | 2012-07-10 08:34:52.400000
 | Registered in Name Of
 | 0
 | 0
BUSINESS FINANCIAL INFORMATION
ASSETS |  |  |  |  |  | LIABILITIES
Cash |  |  |  | $ |  | Accounts Payable |  |  |  | 0
Stocks & Bonds |  |  |  | 0 |  | Line of Credit |  |  |  | 0
Accounts Receivable |  |  |  | 0 |  | Term Loans |  |  |  | 0
Inventory |  |  |  | 0 |  | Real Estate Payable |  |  |  | 0
Equipment |  |  |  | 0 |  | Other Liabilities |  |  |  | 0
Real Estate |  |  |  | 0 |  |  |  |  |  | 0
Other Assets |  |  |  | 0 |  |  | TOTAL LIABILITIES |  |  | 0
 |  | TOTAL ASSETS |  | 0 |  |  | NET WORTH |  |  | 0
BUSINESS AND INDIVIDUAL BANK ACCOUNTS (please include marketable securities and retirement accounts)
Account Type | Bank |  |  | Balance | Pledged for a loan? |  | DISCLOSURES
 |  |  |  |  |  |  | Is the business changing ownership? |  |  | Yes   No
 |  |  |  |  |  |  | Is there any related pending litigation? |  |  | Yes   No
 |  |  |  |  |  |  | Is the business delinquent on any debt? |  |  | Yes   No
 |  |  |  |  |  |  | Any filed complaints the last 3 years? |  |  | Yes   No
 |  |  |  |  |  |  | Has a loss been incurred in the past 3 years? |  |  | Yes   No
EXISTING BUSINESS DEBT (Lines of Credit, Term Loans, Real Estate Loans, Credit Cards)
 |  |  |  |  | Person(s) Liable |  |  |  | Montly
Payable To |  | Address |  | Collateral |  |  |  | Maturity | Payment | Balance Due
 |  |  |  |  |  |  |  | Total | 0 | 0
SIGNATURE(S)
The Business and its Principals and/or Owners (collectively  the "Applicant") acknowledge that this Application is given to Columbia Community Bank (the
"Bank") for the purposes of obtaining credit and that the Bank may retain the Application whether or not credit is granted. The Applicant certifies that all
information included in the Application and provided in support of the Application is true, accurate and complete and that there are not Bankruptcy proceedings
involving the Applicant in process or anticipated.  The applicant authorizes the Bank to obtain information from others on the trade and credit standings of the
Business and Principals or Owners along with other relevant information impacting this Application.  In addition, if credit is granted, the Bank is authorized to
obtain updated trade or credit reports throughout the term of the loan and, except as prohibited by law, to provide information to others about the Bank's
transactions and experience with the Applicant.
 | Signature and Title |  |  | Date |  | Signature and Title |  |  | Date