valuebank texas commercial loan application

ValueBank TexasCommercial Loan Application

Business Information:

Business Name ___________________________________________________________________________________________

Full Street Address ________________________________________________________________________________________

City_____________________________________ County __________________________ State _______ Zip________

Primary Contact ___________________________________ Phone (___)_______________ Fax (___)_________________

Secondary Contact _________________________________ Phone (___)_______________ Fax (___)_________________

Type of Business __________________________________________________________________________________________

________________________________________________________________________________________________________

Type of Entity: Corporation Partnership LLC Sole Proprietorship Other _______________________

Date Business established _____/_____/_______ Tax I.D. _______________________________________________

Business e-mail address _________________________________________

Business Ownership: (Attach additional pages if necessary)

Name ______________________________________________ Title ____________________ % of Ownership _____



Affiliate Businesses, if applicable: (Attach additional pages if necessary)

Name ____________________________________ Address ______________________________________________________

Type of Business ____________________________________________________________________ Tax I.D. ______________

Existing Business Locations: (Attach additional pages if necessary)

Address _______________________________________________ City_____________________ State ____ Zip_____

Rent Own Square Feet ______________________ Monthly Payment _________________________

Address _______________________________________________ City_____________________ State ____ Zip_____

Rent Own Square Feet ______________________ Monthly Payment _________________________

References: (Attach additional pages if necessary)

Bank of Business Account ______________________________ Acct. Officer _______________ Phone ___________

Accountant Name _______________________________________________________________ Phone ___________________

Attorney Name _________________________________________________________________ Phone ___________________

VBT Commercial Loan Application (07/2015/rp)1

Insurance Agent Name ___________________________________________________________ Phone ___________________

Does your company maintain key person life insurance on any owner or officer? Yes No

Life Insurance Agent _____________________________________________________________ Phone ___________________

Name of Insured ________________________________________________________________ Amount $ _________________

Life Insurance Company ____________________________________________ Beneficiary ______________________________

Trade References: (Attach additional pages if necessary)

Contact Person _________________________________________________________________ Phone ___________________

Contact Person _________________________________________________________________ Phone ___________________

Employee Information:

Number of current employees ______: Estimated number of new employees within next two years as a result of this loan _____.

Number of current employees at affiliated businesses _______ (if applicable)

Key Employees: (Attach additional pages if necessary)

Name Title Responsibilities Years withCompany

Years in Industry

Additional Information (Please answer the following questions and provide additional information where necessary):

Have you or any officer of your company ever been involved in bankruptcy or insolvency proceedings? Yes No (If yes, please provide details)

Are you or your business / affiliate involved in any pending lawsuits? Yes No (If yes, please provide details)

Does the business owe any taxes for years prior to the current year? Yes No (If yes, please provide details)

Is the business an endorser, guarantor, or co-maker for obligations not listed on its financial statements? Yes No (If yes, please provide details)

Does your business use or store any hazardous / toxic materials or produce hazardous / toxic materials? Yes No (If yes, please provide details)

Do you or your spouse or any member of your household, or anyone who owns, manages, or directs your business or their spouses or members of their households work for the Small Business Administration, Small Business Advisory Council, SCORE or ACE, any Federal Agency, or the participating lender? Yes No (If yes, please provide details)

Does your business, its owners or majority stockholders own or have a controlling interest in other businesses? Yes No (If yes, please provide details, including their names, relationship with your company, and ownership)

Do you buy from, sell to, or use the services of any concern in which someone in your company has a significant financial interest? Yes No (If yes, please provide details, including their names, relationship with your company, and ownership)

Does your business currently export, or will it start exporting, pursuant to this loan (if approved)? Yes No

If Yes, what is your estimate of the total annual export sales this loan would support $_____________________________

Would you like information on exporting? Yes No


Previous Government Financing, Loans (incl. Student Loans), Debts, and/or Other Obligations: (Attach additional pages if necessary)

If you or any principals or affiliates have ever requested Government Financing complete the following:

Name of Entity Original Amount

of Loan Date of Request Approved or

Declined Balance Current or Past Due

Assistance with preparing this Information: (Attach additional pages if necessary)

List the name(s) and occupations of anyone who you paid or agreed to pay to assist with the preparation of this application:

Name and Occupation Address Total Fees Paid Fees Due

Description of Your Business: (Please attach additional page(s) as needed or substitute with your business plan)

History of your business: ____________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Types of products and/or services (attach any catalogs, brochures, etc.):_______________________________________________

________________________________________________________________________________________________________

History of the business:______________________________________________________________________________________

________________________________________________________________________________________________________

Industry outlook: ___________________________________________________________________________________________

________________________________________________________________________________________________________

How will this loan benefit your business? ________________________________________________________________________

________________________________________________________________________________________________________

Geographic market area where business operates: _______________________________________________________________

________________________________________________________________________________________________________

List key customers: _________________________________________________________________________________________

________________________________________________________________________________________________________

List key competitors: ________________________________________________________________________________________

________________________________________________________________________________________________________

Future Plans: _____________________________________________________________________________________________

________________________________________________________________________________________________________


Project Information: (Attach additional pages if necessary)

Project Description (Explain what you want to do; attach additional pages, if necessary): __________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

Street Address of Project ____________________________________________________________________________________

City _____________________________________________ State ________ Zip __________ County ___________________

Total Project Costs and Uses of Funds: Collateral Offered: If Mortgaged, Present Market Value Present Loan Balance

Real Estate Acquisition $ _____________ Land (vacant) $ _____________ $ _____________

New Construction/Expansion/Repair $ _____________ Land & Buildings $ _____________ $ _____________

Acquisition of Machinery and Equipment $ _____________ Machinery/Equip. $ _____________ $ _____________

Acquisition of Existing Business $ _____________ Furniture $ _____________ $ _____________

Inventory Purchase $ _____________ Leasehold Impr. $ _____________ $ _____________

Working Capital $ _____________ Accounts Rec. $ _____________ $ _____________

Payoff Bank Loan (Copy of notes required) $ _____________ Inventory $ _____________ $ _____________

Other Debt Payment (Details attached) $ _____________ Other $ _____________ $ _____________

All Other ___________________________ $ _____________ Other $ _____________ $ _____________

All Other ___________________________ $ _____________ Other $ _____________ $ _____________

Total Project Costs $ _____________ Total $ _____________ $ _____________

Less: Borrower’s Injection / Down Payment $ _____________

Loan Amount $ _____________; and, Repayment Terms in Years ___________________________ - or - monthly payment amount preferred/requested.

Source of Applicant’s, Injection, and/or Down Payment _________________________________________________

If purchasing real property, how will the property be owned? (i.e. individually, partnership, corporation, trust, etc.) _______________

________________________________________________________________________________________________________ (Please provide appropriate documentation (i.e. Sales/Purchase Contract, Partnership Agreement, Articles of Incorporation, Trust Agreement, etc.)

Please attach copies of bids, purchase orders, invoices, estimates, cost budgets, contracts, etc. for the total project costs above.

I / We certify that the above information and information contained in attachments / exhibits is true and accurate to the best of my / our knowledge.

Name of Applicant (s) ____________________________________________________________________________

Authorized Signature __________________________________________________ Date __________________

Name of Applicant (s) ____________________________________________________________________________

Authorized Signature __________________________________________________ Date __________________


P. O. Box 4956Corpus Christi, Texas 78469

361-888-4451

AUTHORIZATION TO INVESTIGATE CHARACTER & CREDIT HISTORY

The information contained in this statement, including any supplements, is provided to induce ValueBank Texas, its affiliate(s), agent(s), associate(s), participant(s), or other lender(s), collaborator(s), or colleague(s) (hereinafter referred to as VBT) to extend, or consider extending, or continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that VBT is relying on the information provided herein and herewith in deciding to grant or continue credit or to accept a guarantee thereof. Each of the undersigned represents, warrants, and certifies that the information provided herein and herewith is true, correct, and complete. Each of the undersigned agrees to notify VBT immediately and in writing of any change in the information and of any material adverse change in the financial condition or the ability to perform obligations of the undersigned. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. VBT or its agents are authorized to make all inquiries VBT deems necessary to verify the accuracy of the information contained herein and herewith and to determine the credit-worthiness of the undersigned. The undersigned agree to reimburse VBT for any and all expenses incurred in the consideration, making, and/or administration of any and all loans or other extensions of credit related hereto. The undersigned authorize any consumer, commercial, or credit reporting agency, creditor, employer, reference, or any other person or entity to give VBT, its agents, associates, etc., any information it may have on the undersigned. The undersigned further authorizes VBT, its agents, associates, etc., to share all information. This statement and any other information that the undersigned furnish to VBT or that VBT obtains hereinafter related shall be VBT property whether credit is extended or not.

FULL NAME: _____________________________________________________________________

ADDRESS: _____________________________________________________________________

CITY: ________________________________ STATE: ______________ ZIP:___________

SOCIAL SECURITY # ________________________________ DATE OF BIRTH:______________________

SIGNATURE: _____________________________________________________________________

DATE: ________________________________ PHONE # : __________________________

PLEASE COMPLETE FOR JOINT REQUESTS:

FULL NAME: _____________________________________________________________________

ADDRESS: _____________________________________________________________________

CITY: ________________________________ STATE: ______________ ZIP: ___________

SOCIAL SECURITY # ________________________________ DATE OF BIRTH:______________________

SIGNATURE: _____________________________________________________________________

DATE: ________________________________ PHONE # : __________________________


Customer/Applicant Identification Form

Applicant

___________________________________________________________________________________________________________Name

___________________________________________________________________________________________________________Address

___________________________________________________________________________________________________________(Physical Address, or directions if above is a P.O. Box #)

___________________________________________________________________________________________________________City, State, Zip Code

___________________________________________________________________________________________________________Email Address

_______________________________________Date of Birth

_______________________________________ _______________________________________ Social Security # or TIN # SSN Issue Date

_______________________________________ _______________________________________ ID# ID Issuer (State)

_______________________________________ _______________________________________ ID Issue Date ID Expiration Date

Veri�ed by:

_____________________Initials


Customer/Applicant Identification Form

Co-Applicant

___________________________________________________________________________________________________________Name

___________________________________________________________________________________________________________Address

___________________________________________________________________________________________________________(Physical Address, or directions if above is a P.O. Box #)

___________________________________________________________________________________________________________City, State, Zip Code

___________________________________________________________________________________________________________Email Address

_______________________________________Date of Birth

_______________________________________ _______________________________________ Social Security # or TIN # SSN Issue Date

_______________________________________ _______________________________________ ID# ID Issuer (State)

_______________________________________ _______________________________________ ID Issue Date ID Expiration Date

Veri�ed by:

_____________________Initials


Commercial Credit Denial Notice

Commercial Credit Denial Notice To �e Commercial Applicant:

If your gross revenues were 1,000,000.00 or less in your previous �scal year, or you are requesting trade credit, a factoring agreement, or similar types of business credit in the Commercial Loan Application, and if you application for business credit is denied, you have the right to a wri�en statement of the speci�c reasons for the denial. To obtain the statement please contact...

VALUEBANK TEXAS3649 LEOPARD STREET

CORPUS CHRISTI, TX 78408

within 60 days from the date you are noti�ed of our decision. We will send you a wri�en statement of reason for the denial within 30 days of receiving your request for the statement. �e notice that follows describes additional protections extended to you.

EQUAL CREDIT OPPORTUNITY NOTICE: �e federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, martial status, age (providing the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance program, or because applicant has in good faith exercised any right under the Consumer Credit Protection Act. �e federal agency that administers compliance with this law concerning this creditor is:

FEDE�L DEPOSIT INSU�NCE COMPANY1100 WALNUT STREET, SUITE 2100

�NSAS CITY, MO 641061(800)209-7459


Other Important Information

ValueBank Texas is chartered under the laws of the State of Texas and by state law is subject to regulatory oversight by the Texas Department of Banking. Any consumer wishing to �le a complaint against ValueBank Texas should contact the Texas Department of Banking.

ValueBank Texas also engages in the money transmission and currency exchange business as an authorized delegate of American Express. MoneyGram and Currency Exchange International under Chapter 151 of the Texas Finance Code. If you have a complaint, first contact the consumer assistance division of MoneyGram at (800)-549-3590 or Currency Exchange International at, (888)-998-3948 if you still have an unresolved complaint regarding the company’s money transmission or currency exchange activity, please direct your complaint to Texas Department of Banking.

Consumers/customers may �le complaints with the Texas Department of Banking by contacting the Department through one of the means indicated below:

In Person or U.S. Mail to....

Telephone Number............. Fax Number.......................... E-Mail Address.................... Website..................................

Texas Department of BankingAttention: Consumer Assistnance Activities2601 North Lamar Boulevard (877)276-5554 (toll free)(512)[email protected] www.dob.texas.gov

�ank you very much for banking with ValueBank Texas. We are proud to have you as a customer and you may rest assured that we are doing everything possible to protect the privacy of the �nancial information you have entrusted us with.

Other Important Information


Privacy Disclosure

WHAT DOES VALUEBANK TEXAS DO WITH YOUR PERSONAL INFORMATION

Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share and protect your personal information. Please read this notice carefully to understand what we do.

�e types of personal information we collect and share depends on the product or service you have with us. �is information can include:

• Social Security Number and Income• Account Balances and Payment History• Credit History and Credit Scores

When you are no longer our customer, we continue to share your information as described in this notice.

All �nancial companies need to share customers’ personal information to run their everyday business. In the section below, we list the reason �nancial companies can share their customer’s personal information: the reasons ValueBank Texas chooses to share; and whether you can limit this sharing.

FACTS

Why?

What?

How?

Questions? Call (361)888-4451 or go to valuebanktexas.com

Reasons we can share your personal information Does ValueBank Texas share? Can you limit this sharing?For our everyday business purposes - such as to process your transactions, maintain your account(s), respond to court orders and legal investigations

Four our marketing purposes - to o�er our products and services to you

For joint marketing with other �nancial companies

For our a�liates’ everday business purposes - information about your transactions and experiences

For our a�liates’ everyday business purposes - information about your credit worthiness

For our a�liates to market to you

For non-a�liates to market to you

Yes No

Yes No

No We Do Not share

No We Do Not share

No We Do Not share

No We Do Not share

No We Do Not share

What We Do

Who We Are

Who is providing this notice? ValueBank Texas

How does ValueBank Texas protect my personal information?

How does ValueBank Texas collect my personal information?

Why can’t I limit all sharing?

To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. �ese measures include computer safeguards and secured �les and buildings.

We collect your personal information, for example, when you• Open an account• Pay your bills or apply for a loan• Use your debit or credit card

Federal law gives you the right to limit only• Sharing for a�liates’ everyday business purposes - information about

your credit worthiness• A�liates from using your information to market to you• Sharing for non-a�liates to market to you

State laws and individual companies may give you additional rights to limit sharing

A�liates Companies related by common ownership or control. �ey can be �nancial or non-�nancial companies

Non-A�liates Companies not related by common ownership or control. �ey can be �nancial or non-�nancial companies

Joint Marketing A formal agreement between non-a�liated �nancial companies that together market �nancial products or services to you

De�nitions

10

Additional Needed Documentation, Checklist: (Please supply the following information, as applicable) (All information should be signed & dated)

Business Information:

Business Tax Returns for the past three years.

Interim Financial Statements (P&L and Balance Sheet) within 45 days of application (form attached).

Listing & Aging of Accounts Receivable and Accounts Payable dated the same date as the interim financial statements.

Business Debt Schedule dated the same date as the interim financial statements (form attached).

Projections of Income & Expenses for next 3 years, if loan approved, with supporting assumptions (forms attached).

Legal Entity Documents: • Articles of Incorporation, Certificate of Incorporation, and By-laws for corporations.• Articles of Organization, Articles of Formation, and Operating Agreement for LLCs.• Partnership Agreement for partnerships.

Copies of Assumed Name Certificate(s) and Business License(s).

Franchise Agreement and FTC Disclosure Document for licensed franchises.

Copy of existing or new leases to be entered.

Affiliate Business Information:

Business Tax Returns for the past three years (signed and dated).

Interim Financial Statements (P&L and Balance Sheet) within 45 days of application (form attached).

Business Debt Schedule dated the same as the interim financial statement (form attached).

Legal Entity Documents: • Articles of Incorporation, Certificate of Incorporation, and By-laws for corporations.• Articles of Organization and Operating Agreement for LLCs.• Partnership Agreement for partnerships.

Assumed Name Certificate and Business License.

Franchise Agreement and FTC Disclosure Document (if applicable).

Personal Information: (for each owner)

Personal Tax Returns for the past three years.

Personal Resume for each owner / shareholder / guarantor. (form(s) attached).

Personal Financial Statement for each owner / shareholder / guarantor. (form(s) attached).

Collateral Information:

Real estate Sale/Purchase Agreement, Title Company Settlement Statement, and/or Deed.

Asset purchase agreement & copy of bill of sale for business acquisition.

Construction cost-budget and/or bids.

Equipment cost-budget and/or bids.

Existing environmental studies, appraisals, and surveys on the property.


PERSONAL RESUME/INFORMATION (Please complete for each owner of the business)

Name _______________________________________________________ Social Security No. ______________________ First Middle Initial Last

Home Phone ___________________ Business Phone __________________ Cell Phone ______________________

Address _________________________________________ City______________________ State _______ Zip_________

Immediate past address _____________________________ City______________________ State _______ Zip_________

From ________/________ To _______/________ e-mail address _________________________________________

Driver’s License / Passport # ___________________________ Issuer (State or Country) __________________________

Issue Date ___________ Exp. Date _________ Verified Initials ___________ For Bank Use Only

Spouse’s name* ___________________________________________________________________________________________ First Middle Initial Last

*You are not required to provide information regarding a spouse unless the spouse is a co-applicant for the loan, you are relying on the spouse’s income for repayment of the loan, you reside in a community property state, the proposed business is located in such a state, or you are relying on alimony, child support, or separate maintenance as a source of repayment.

EDUCATION: (High School, College or Technical Training)

Name and Location Dates Attended Major Degree / Certificate

__________________________ _________________________ ___________________ _________________________

__________________________ _________________________ ___________________ _________________________

__________________________ _________________________ ___________________ _________________________

__________________________ _________________________ ___________________ _________________________

WORK EXPERIENCE: (List chronologically beginning with present employment)

Name of company _________________________________________________________________________________________

Address _________________________________________ City______________________ State _______ Zip__________

From ________/________ To _______/________ Title _________________________________________________________

Job Description ___________________________________________________________________________________________

Name of company _________________________________________________________________________________________


From ________/________ To _______/________ Title _________________________________________________________

Job Description ___________________________________________________________________________________________

Name of company _________________________________________________________________________________________


From ________/________ To _______/________ Title _________________________________________________________

Job Description ___________________________________________________________________________________________


PERSONAL FINANCIAL STATEMENT

As of ,

Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.

Name Business Phone

Residence Address Residence Phone

City, State, & Zip Code

Business Name of Applicant/Borrower

ASSETS

Cash on hand & in Banks Savings Accounts IRA or Other Retirement Account Accounts & Notes Receivable Life Insurance-Cash Surrender Value Only

(Complete Section 8)

Stocks and Bonds (Describe in Section 3)

Real Estate (Describe in Section 4)

Automobile-Present Value Other Personal Property

(Describe in Section 5)

Other Assets (Describe in Section 5)

Total

Section 1. Source of Income

Salary

Net Investment Income

Real Estate Income

Other Income (Describe below)*

Description of Other Income in Section 1.

(Omit Cents) LIABILITIES (Omit Cents)

$ Accounts Payable $ $ Notes Payable to Banks and Others $ $ (Describe in Section 2) $ Installment Account (Auto) $ $ Mo. Payments $

Installment Account (Other) $ $ Mo. Payments $

Loan on Life Insurance $ $ Mortgages on Real Estate $

(Describe in Section 4) $ Unpaid Taxes $ $ (Describe in Section 6)

Other Liabilities $ $ (Describe in Section 7)

Total Liabilities $

Net Worth $ $ Total $

Contingent Liabilities

$ As Endorser or Co-Maker $ $ Legal Claims & Judgments $ $ Provision for Federal Income Tax $ $ Other Special Debt $

*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.

(Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)Section 2. Notes Payable to Banks and Others.

Original Current Payment Frequency How Secured or EndorsedName and Address of Noteholder(s) Balance Balance Amount (monthly,etc.) Type of Collateral


Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed).

Number of Shares Name of Securities Cost Market Value Date of Total ValueQuotation/Exchange Quotation/Exchange

Section 4. Real Estate Owned. (List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed.)

Property A Property B Property C

Type of Property

Address

Date Purchased

Original Cost

Present Market Value

Name &Address of Mortgage Holder

Mortgage Account Number

Mortgage Balance

Amount of Payment per Month/Year

Status of Mortgage

(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, termsSection 5. Other Personal Property and Other Assets. of payment and if delinquent, describe delinquency)

Section 6. Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)

Section 7. Other Liabilities. (Describe in detail.)

Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies - name of insurance company and beneficiaries)

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).

Signature: Date: Social Security Number:

Signature: Date: Social Security Number:


Cash Flow Statement

STATEMENT DATE

CASH FLOW FOR PERSONAL FINANCIAL STATEMENTINCOME Monthly Year Projected Next Yr.

Salary/WagesBonus/CommissionsDividends/InterestTrust IncomeRentals/R.E. Income (net exp.)RoyaltiesCapital GainsEquipment LeasesGifts/InheritancesLegal/Insurance SettlementsTax RefundSpouse IncomeOther

TOTAL INFLOWS

EXPENSESHousing (Mortgage or Rent)Auto PaymentOther Loan PaymentsCredit Card PaymentsInsurance Payments (Car, Home, Life, Health)Property Taxes (if not included in mortgage)Electric/Gas Bill/WaterPhone BillGasolineGroceriesChild SupportChild CareOther Living Expenses

TOTAL OUTFLOWS (Expenses)NET CASH FLOW (Income - Expenses)

-$ -$

-$ -$

-$ -$

-$ -$ -$

$ $ $


DATE SIGNATURE

DATE CO-APPLICANT'S SIGNATURE (if you are requesting joint credit)

VALUEBANK TEXAS (361) 888-4451 (361) 866-7791 Fax www.valuebanktexas.com

P.O. BOX 4956, CORPUS CHRISTI, TEXAS 78469-4956

The information contained in this statement, including any supplements, is provided to induce ValueBank Texas, its affiliate(s), agent(s), associate(s), participant(s), or other lender(s), collaborator(s), or colleague(s) (hereinafter referred to as VBT) to extend, or consider extending, or continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that VBT is relying on the information provided herein and herewith in deciding to grant or continue credit or to accept a guarantee thereof. Each of the undersigned represents, warrants, and certifies that the information provided herein and herewith is true, correct, and complete. Each of the undersigned agrees to notify VBT immediately and in writing of any change in the information and of any material adverse change in the financial condition or the ability to perform obligations of the undersigned. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. VBT or its agents are authorized to make all inquiries VBT deems necessary to verify the accuracy of the information contained herein and herewith and to determine the credit-worthiness of the undersigned. The undersigned agree to reimburse VBT for any and all expenses incurred in the consideration, making, and/or administration of any and all loans or other extensions of credit related hereto. The undersigned authorize any consumer, commercial, or credit reporting agency, creditor, employer, reference, or any other person or entity to give VBT, its agents, associates, etc., any information it may have on the undersigned. The undersigned further authorizes VBT, its agents, associates, etc., to share all information. This statement and any other information that the undersigned furnish to VBT or that VBT obtains hereinafter related shall be VBT property whether credit is extended or not.


" PROJECTED " BUSINESS INCOME & EXPENSE STATEMENT (P&L)

(Assume 12 month periods, if requested loan is obtained)

BUSINESS NAME:

YEAR: 1 YEAR: 2 YEAR: 3

INCOME: $ $ $Gross Revenue: Less: Returns & AllowancesNet Revenue: $ $ - Less: Cost of Goods Sold:Gross Profit: $ $ - Other Income:Total Gross Income: $ $ -

EXPENSES: $ $ $AdvertisingCar & Truck ExpenseCommissions & FeesContract LaborDepreciationInsuranceInterest ExpenseLegal & ProfessionalLicenses & PermitsOffice ExpensePostageRentRepairs & MaintenanceSuppliesTelephoneTravel & EntertainmentUtilities (Electric, Water, Gas, Garbage)Wages (Employee Payroll)Payroll TaxesProperty Taxes (Real Estate & Property)Other Expenses:Total Expenses: $ $ -

NET PROFIT: $ $ -

Estimated Income Taxes:Owners/Officers Withdrawal (W/D)

NET PROFIT after W/D & Inc Taxes: $ $ -$

Authorized Signature: _______________________________________________ Date: _______________


ASSUMPTIONS FOR PROJECTIONS

BUSINESS NAME

Please use this page to explain the assumptions used to generate the three year projection figures. Outline the specific reasons as to why the projected figures differ from previous years for Revenues, Cost of Goods Sold, Other Income, and Operating Expenses. Use the comments section for additional information.

EXPLANATIONS:

Revenues:

Cost of Goods Sold:

Other Income:

Operating Expenses:

Comments:


SCHEDULE OF BUSINESS DEBT & OTHER FIXED OBLIGATIONS (SCHEDULE OF NOTES, CONTRACTS, LEASES, ETC PAYABLE)

Please furnish information on all mortgage debt, notes, installment debt, contracts, leases, and other fixed obligations. This schedule should be as of the same date as the interim financial statement balance sheet. “Total Present Balance” should equal the debt shown on the interim financial statement balance sheet. Under status, please indicate whether the loan / lease / or contract is current or delinquent. (Use additional pages, if needed)

Creditor Name and Address Account Number

Original Date

Maturity Date

Original Amount

Present Loan Balance

Int. Rate

Payment Frequency

No. of Payment

Remaining Payment Amount Collateral Status

Total Present Balance

$ Total Monthly Payment $

Authorized Signature _________________________________________ Date ____________________


SCHEDULE OF MACHINERY, EQUIPMENT, FURNITURE, & OTHER NON-REAL ESTATE ITEMS

Please furnish information on all machinery, equipment, furniture, and other non-real estate items. (Use additional pages, if needed)

Description, Make or Manufacturer Model Year

Serial Number

(for items valued $500+)

Date Acquired

Original Cost

Present Value

Current Loan Balance

Lien Holder

Authorized Signature _________________________________________ Date ____________________
