Quick Application Form

Loan Officer/Mortgage Broker

Are you a Mortgage Broker?

Yes No

Please select your Mortgage Broker?

Email Address

First Name

Last Name

Company Name

Phone Number

What program are you interested in?

SBA Loan product

Where are you in the process?

Lead Source

Please verify you are human!

Borrower Info

Legal First Name

Legal Middle Name

Legal Last Name

Borrower Email

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Secondary Email

Home Phone

Cell Phone

Fax

Cell Carrier

Preferred Communication

Is there a Co-borrower?

Alt. Phone #

Work Phone #

Borrower Primary Address

Borrower Primary Unit # / Suite #

Borrower Primary City

Borrower Primary State

Borrower Primary Zip Code

County

Borrower Primary Country

Years at Primary Address

Length Of Time At The Present Property Months

Rent or Own

Rent Per Month Current Address

Borrower providing Personal Guaranty

Yes No

Previous Address

Previous Unit #

Previous City

Previous State

Previous Zip Code

Previous Country

Length of time at the previous property

Length Of Time At The Previous Property Months

Rent or Own

Rent Per Month Previous Address

Mailing Address

Mailing Address same as Current Address?

Borrower Mailing Address

Borrower Mailing Address Unit#

Borrower Mailing City

Borrower Mailing State

Borrower Mailing Zip Code

Borrower Mailing Address Country

Alternate Names

Alternate Section 1

First Name

Credit Info

Borrower Date Of Birth

Place Of Birth

Borrower Social Security Number

Borrower Driver License State

Borrower Driver License Number

Driver License Issuance Date

Driver License Expiration Date

Borrower Marital Status?

Unmarried Married Separated

Date of Marriage

Date of Divorce (If applicable)

Borrower Maiden Name

Full name of Spouse if not on mortgage

Borrower Citizenship

U.S. Citizen Perm Resident Non-Perm Resident Foreign National

Are you currently serving, or previously served, in the United States Armed Forces?

Yes No

Servicing member Info

Projected Expiration Date of Service/Tour

Ages Of Dependents

Number Of Dependents

Representative FICO Score

Borrower Equifax Score

Borrower Transunion Score

Borrower Experian Score

Borrower Estimated Credit Score Range

Co-borrower/Sponsor Info

Co-borrower Legal First Name

Co-borrower Legal Last Name

Co-borrower Email Address

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Co-borrower Home Phone

Co-borrower Cell Phone

Fax

Co-borrower Mobile Service Provider

Same as borrowers address?

Co-borrower Primary Address

Co-borrower Primary City

Co-borrower Primary State

Co-borrower Primary Zip Code

Rent or Own

Is the Co-Borrower Guaranteeing the loan?

Yes No NA

Co-borrower Length of time at primary address

Co-Borrower providing Personal Guaranty

Yes No

Previous Address

Previous City

Previous State

Previous Zip Code

Rent or Own

Mailing Address

Same as borrowers mailing address?

Co-borrower Mailing Address

Co-borrower Mailing City

Co-borrower Mailing State

Co-borrower Mailing Zip

Credit Info

Co-borrower Date Of Birth

Place Of Birth

Co-borrower Social Security Number

Co-borrower Driver License State

Driver License Number

Driver License Issuance Date

Driver License Expiration Date

Co-borrower Marital Status?

Unmarried Married Separated

Married to Borrower?

Yes No

Co-borrower Citizenship

U.S. Citizen Perm Resident Non-Perm Resident Foreign National

Co-borrower Equifax Score

Mid Fico Score

Co-borrower Transunion Score

Co-borrower Experian Score

Co-borrower Estimated Credit Score Range

Vesting Info

Borrower Type

Trust Type

Retirement Entity

General Business Info

Entity Name

Trade Name/DBA

Entity Type

Date of Formation

Time in Business

State of Formation

States Registered In

Federal Tax ID/EIN

Business License Number

Issuance Date

Expiration Date

State Issued

Other States Operating In

DBA Name(s)

Prior Business Name(s)

Organizational Ref #

Business Phone

Website Address

Business Address

Start Date at Location

Entity Mailing Address

Address 2/Suite/Unit #

Entity Mailing City

Entity Mailing State

Entity Mailing Zip Code

Is the billing address the same as above?

Billing Address

Billing City

Billing State

Billing Zip Code

Location

Urban Rural Suburban

Property Ownership

Value of Property?

Total Debt on Property?

Name of Lender(s)?

Landlord/Mortgage Contact Name

Landlord/Mortgage Phone

Rent/Mortgage Payment

Business Details

Business Type

# of employees currently

# of employees after loan

Business Category

Type of product or service sold

Naics Code

NAICS Code look up

Does your business sell a

Service Product

Is your Business

B2B B2C

Is your business home based?

Yes No

Do you take credit card payments?

Yes No

Terminal/ POS Make/Model

How many card processor banks do you have active?

Merchant Processing Bank Name(s)

Do you charge sales tax?

Yes No

How are employees paid?

Do you have more than one business location?

Yes No

How many locations?

Other Location Details & Addresses

Is the business a franchise?

Yes No

Name of Franchise

Point of Contact

Point of Contact Phone

Point of Contact E-mail

Website for Franchise

is your business seasonal?

Yes No

if Yes, what are the peak months?

Business Description

Do you have Business Reference(s)?

Yes No

Phone Name

Company

Fax

Business Financials

Average Monthly Credit Card Sales

Average Monthly Deposits

Annual Revenue

Annual Gross Profit

YTD-Net Business Income

Date of Operating Agreement

Gross Annual Revenues $

Gross Income Last Year

Net Income Last Year

Gross Income 2 years ago

Net Income 2 years Ago

Average Bank Balance

Has business ever filed for bankruptcy?

Yes No

Status of Business Bankruptcy

Recent NSFs

Does your business owe taxes for years prior to the current year?

Yes No

Estimated amount owed

Members/Officers (List all members with 20% ownership or more.)

Name

Title

% of Ownership

Annual Salary/Compensation

Address

Phone

Cell

SSN

DOB

Credit Score

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

Drivers License State

Drivers License

Member TIN

Personal Guarantee for this loan

Yes No

Authorized signer for making loans

Yes No

Citizenship

U.S. Citizen Perm Resident Non-Perm Resident Foreign National

Name

Title

% of Ownership

Annual Salary/Compensation

Address

Phone

Cell

SSN

DOB

Credit Score

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

Drivers License State

Drivers License

Member TIN

Personal Guarantee for this loan

Yes No

Authorized signer for making loans

Yes No

Citizenship

U.S. Citizen Perm Resident Non-Perm Resident Foreign National

Name

Title

% of Ownership

Annual Salary/Compensation

Address

Phone

Cell

SSN

DOB

Credit Score

Marital Status

Unmarried Married Separated

Date of Marriage

Date of Divorce(If applicable)

Maiden Name

Full name of Spouse if not on mortgage

Drivers License State

Drivers License

Member TIN

Personal Guarantee for this loan

Yes No

Authorized signer for making loans

Yes No