Spreadsheet: 475c5342-2198-4663-836a-7f2503ee6e1b
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13
 |  |  |  |  |  |  |  | APPLICATION FOR BUSINESS LOAN
LOAN REQUEST
The undersigned hereby submit(s) a business loan application in the net amount of:
 |  |  |  |  |  |  |  |  |  |  | Dollars
For the purpose of:
BUSINESS PROFILE
 |  |  |  |  |  |  |  |  |  |  |  |  | Corporation
 |  |  |  |  |  |  |  |  |  |  |  |  | Partnership
Name of Business: |  |  |  |  |  |  |  |  |  |  |  |  | Proprietorship
Type of Business: |  |  |  |  |  |  |  |  |  |  | TIN:
Address: |  |  |  |  |  |  |  |  |  |  | Telephone:
Year Business Established:
Business Checking Account:
INFORMATION CONCERNING OWNER(S) AND GUARANTOR(S)
Name |  | Address |  |  |  |  |  |  |  | Title | %Ownership | Social Security
GENERAL INFORMATION
Has the business, or any of the principals ever been in any judgments, attachments or other legal proceeding other than divorce, custody, alimony or separate support proceedings?
Y ______ | N ______ | If Yes, attach memorandum giving details.
Name of Accountant: |  |  |  |  |  |  |  |  |  |  | Telephone:
Address:
Insurance Agent: |  |  |  |  |  |  |  |  |  |  | Telephone:
Address:
Name of Attorney: |  |  |  |  |  |  |  |  |  |  | Telephone:
Address:
APPLICANT'S LOAN CHECKLIST - SUPPORTING INFORMATION
1. Corporate Resolutions or Partnership Agreement
2. [NAME] of Business plus Current Interim
3. Personal Financial Statement for all Partners - Current
4. [NAME] for both Business and Personal
REPRESENTATIONS
Borrower, in consideration for the Bank making a loan to Borrower, hereby warrants, represents and agrees as follows:
1. If [NAME] is a corporation, Borrower is duly organized and existing under the laws of ____________________ and/or is duly qualified as a foreign corporation in the State(s) of ________________________________________________.
2. The execution, delivery and performance hereof of any security instruments or guarantees called for or delivered hereunder, have been duly authorized, are not in contravention or the terms of Borrower's Articles of Incorporation or By-Laws or any amendment thereof and (whether or not Borrower is a corporation) are not in contravention of law or of any indenture, agreement or undertaking to which Borrower is a party or by which Borrower is bound.
3. All financial statements, profit and loss statements, statements as to ownership and other statements heretofore or hereafter given to Bank in connection with this agreement are or will be true and correct subject to any limitations stated therein and Borrower is the owner of all property in which Borrower hereafter gives as security interest to Bank.
4. Borrower will maintain adequate fire (including so-called extended coverage), public liability and other insurance as Bank may require, in such form and written by such companies as may be satisfactory to Bank and will upon request of bank deliver to it the policies concerned. All policies covering property given as security for the loan shall have a loss payable clause in favor of Bank. A ten day notification will be required by the bank upon termination of any such insurance policies.
The foregoing statements and any supplementary information are warranted by the undersigned to be true and are furnished to induce you to make the loan applied for, which, if made, will be used only for the purpose stated above.
The Bank is authorized to obtain from any source any information which it may require to enable or assist it to pass upon this application.
The undersigned knows that you rely and will continue to rely upon the information supplied herein until written notice of any change therein is received by you. The undersigned will give you immediate written notice of any material change in the undersigned's financial condition, including any lawsuit, begun or threatened, the effect which may be to materially alter the said condition.
The undersigned will furnish you with such financial statements and data at such times and with such certifications as you may require, without expense to you. You, and your agents and accountants, may at any time inspect the undersigned's books and records.
This application shall remain the property of the Bank, whether approved, not approved, withdrawn, or if the loan is paid.
IN ORDER TO COMPLY WITH THE USA PATRIOT ACT AND FEDERAL REGULATION, ROCKVILLE BANK IS REQUIRED TO NOTIFY YOU OF THE FOLLOWING IMPORTANT INFORMATION WHEN YOU OPEN A NEW ACCOUNT.
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 to you: When you open an account, we will ask for your name, address, (Postal office boxes unacceptable), date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents on behalf of a business entity, documents relating to the business may also be required. We may also use non-documentary methods to verify your identity.
 | Photo Drivers License
ID# |  |  |  |  |  | State |  | Issue Date |  | Exp Date |  | DOB
ID# |  |  |  |  |  | State |  | Issue Date |  | Exp Date |  | DOB
ID# |  |  |  |  |  | State |  | Issue Date |  | Exp Date |  | DOB
Signed this
 |  |  |  | Day |  |  | Month |  | Year
 |  |  |  |  |  |  | Name of Applicant
By: |  |  |  |  |  |  |  |  |  | Title
By: |  |  |  |  |  |  |  |  |  | Title
I acknowledge that I have reviewed forms of identification that confirms the identity of the above signors.
Bank Representative: |  |  |  |  |  |  |  |  |  | Date