Commercial Application

First Name:

Last Name:

Residence Address:

Residence Phone:

City:

State:

Zip Code:

Business Name of Applicant/Borrower:

Assets (Omit Cents)

Cash on hand & in Banks:

Savings Accounts:

Total Assets:

Liabilities (Omit Cents)

Accounts Payable:

Notes Payable to Banks and Others:

Unpaid Taxes:

Total Liabilities:

Net Worth:

Total:

Source of Income

Salary:

Other Income:

Description of Other Income:

Other Personal Property and Other Assets

Describe Personal Property and Assets:

Unpaid Taxes:

Other Liabilities:

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).

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