Spreadsheet: 355c1093-75d2-4ccd-864b-b4e20b601d11
Sheet: Sheet1

REQUESTED LOAN AMOUNT | Unnamed: 1 | PURPOSE | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6
APPLICANT TYPE
REQUESTED LOAN TYPE
CORPORATION OR PARTNERSHIP INFORMATION
CORP OR PARTNERSHIP NAME |  |  |  | TIN
ADDRESS
E-MAIL ADDRESS: |  |  |  | PHONE
CORP. OFFICERS & TITLES
PARTNERS & % OWNERSHIP
PERSONAL INFORMATION
BORROWER NAME |  | BIRTH DATE |  | SS #
CO BORROWER NAME |  | BIRTH DATE |  | SS #
ADDRESS |  |  |  | PHONE
E-MAIL ADDRESS |  |  |  | CELL PHONE
OCCUPATION |  |  |  | ANNUAL INCOME
BASIC CREDIT & LEGAL INFORMATION
HAS THE BORROWER EVER BEEN INVOLVED IN BANKRUPTCY?
HAVE YOU FILED ALL NECESSARY STATE & FEDERAL INCOME TAX RETURNS?
ARE ANY TAXES DELINQUENT OR UNDER DISPUTE?
ARE YOU A DEFENDANT IN A LEGAL ACTION, OR HAVE JUDGMENTS OR MECHANIC'S LIENS OUTSTANDING?
LIST ANY CONTINGENT LIABILITIES AS ENDORSER, COSIGNER, OR GUARANTOR (NAMES & AMOUNTS)
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
INSURANCE COVERAGES | AMOUNT |  | AGENCY
BUILDINGS   $
EQUIPMENT   $
LIABILITY  $
LIFE  (GUARANTORS)  $
MEDICAL  $
DISABILITY  $
IF PURPOSE IS REAL ESTATE
PURCHASE PRICE |  |  | DOWN PAYMENT AVAILABLE
PAYMENT SCHEDULE
 |  |  | REQUESTED TERM IN YEARS
Were your gross revenues $1,000,000 or less in your previous fiscal year?
If you answered "yes" and the Creditor denies your application for credit, you have the right to a written statement of the specific reasons for the denial.  To obtain the statement please contact:
 | ALLIANCE BANK
 | 101 W Montgomery St; PO Box 188
 | [NAME] IN 47946
within 60 days from the date you are notified of Creditor's decision.  The Creditor will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.  The notice at right describes additional protections extended to you.
To obtain and maintain credit from time to time, in any form whatsoever, with Alliance Bank (Alliance), for claims and demands against the undersigned, the undersigned submits this information as being a true and accurate statement of his/hers/its financial condition on the date signed, and agrees that if any change occurs that materially reduces the means and ability to pay all claims or demands against them, the undersigned will immediately notify Alliance Bank.  Unless Alliance is so notified it may continue to rely upon the statement herein given as a true and accurate statement of the financial condition of the undersigned.  Alliance is hereby authorized to make any and all inquiries it deems necessary to verify the accuracy of the statements herein made.  Alliance is further authorized to answer any questions from third parties concerning the undersigned's experience with Alliance.
SIGNATURE _____________________________________________________________________ |  |  |  |  |  | DATE  ____________
SIGNATURE _____________________________________________________________________ |  |  |  |  |  | DATE  ____________