Front Street Advisors - Working Capital Loan

PRE-QUALIFICATION QUESTIONNAIRE

Thank you for your interest in applying for a small business working capital loan. Front Street Advisors, Ltd. will be assisting you in the process. Please fill out and sign this form and we will use the information provided to fill out the applicable loan documents on your behalf to our lending partners.

Tell Us About Your Business

Legal Business Name

DBA Name (if applicable)

Loan Amount Requested Must not be over $150,000 or 30% of yearly Sales

Business Structure (i.e. LLC, Corp etc)

Number of Employees

Business Industry

Does your business operate out of your home?

Tax ID Number

Date Business Established MM/DD/ YYYY

State of Incorporation

Business Address

Business City

Business State

Business Zip

Business Phone Number

Estimated Fair Market Value of all your Business Assets

Use of Proceeds (Provide Dollar amounts where applicable) Combined total must not exceed requested loan amount

Payroll/Hiring Expenses

Marketing Expenses

Supplies

Accounts Payable

Operational Expenses

Total

Do you own or rent the property where the business is located?

Does the business or any of the owners have a controlling interest in any other businesses?

Is the business or any of the business affiliates involved in any pending litigation?

Does the business or any of its owners have any outstanding judgements or tax liens?

Does the business or any of its owners have any outstanding tax liabilities?

Tell us about the business Ownership

How many 20% or more owners are in the business?

Provide brief description of the management team, time under current management and industry experience

Owner 1 First and Last Name

Owner 1 Street Address

Owner 1 City, State and Zip

Is Owner 1 a U.S. Citizen or Legal Permanent Resident?

Owner 1 Phone Number

Owner 1 Email Address

example@example.com

Owner SSN

My Credit Score is above a 700

Does this owner/principal have more than $75,000 in credit card debt?

Has this owner/principal filed for bankruptcy or foreclosure in the past 3 years?

Has this owner/principal ever been convicted; plead guilty; plead nolo contendere; placed on pretrial diversion; or placed on any form of parole or probation?

Owner 2 Information (If Applicable)

Owner 2 First and Last Name

Owner 2 Address

Owner 2 City, State and Zip

Is Owner 2 a U.S. Citizen or Legal Permanent Resident?

Owner 2 Phone Number

Owner 2 Email Address

example@example.com

Owner 2 SSN

My Credit Score is above a 700

Does this owner/principal have more than $75,000 in credit card debt?

Has this owner/principal filed for bankruptcy or foreclosure in the past 3 years?

Has this owner/principal ever been convicted; plead guilty; plead nolo contendere; placed on pretrial diversion; or placed on any form of parole or probation?

Please Submit: Drivers License (of all 20% Owners) Most Recent Tax Personal Tax Return (of all 20% owners) 2 Years Business Tax Returns (and all businesses you own 50% or more of)

I understand that this loan application is for a business loan. The funds can only be used for business related purposes. I authorize BayFirst or any credit bureau or investigative agency employed by BayFirst to check my references, credit and employment history.I understand that a consumer report may be requested in connection with this credit application. If requested, I may be informed whether or not a consumer report(s) were requested, and if such reports were requested, I will be informed of the name and address of the consumer reporting agency that furnished the report. BayFirst may at any time in the future obtain additional credit reports to review my account. I authorize BayFirst National Bank to release and otherwise share my private personal and business information with my SBA Approved Counseling Center (SBDC or SCORE) and any broker which referred the loan application to BayFirst Nation- al Bank, and likewise, for my Counseling Center and or broker to release and other wise share my private personal and business information with BayFirst National Bank. The Bank may, at its discretion, file one or more UCC-1's prior to the Closing Date to ensure the Bank's priority interest in the collateral required by the Bank or the SBA to secure the payment of the principal, interest and all other amounts due with regard to the Loan made by the Bank to Borrower and/or any entity that Borrower may form in connection with the Loan. If this Loan does not close for any reason, the Bank will file a UCC-3 terminating its interests. SBA permits a third party to charge an Applicant fees for packaging and other services. Prior to any services being provided, the 7(a) Lender must advise the Applicant in writing that the Applicant is not required to obtain or pay for unwanted services.

By submitting this form, I authorize BayFirst National Bank to contact me through a landline, a paging service, a cellular wireless service, a specialized mobile radio service, other radio common carrier service or any other service for which I may be charged for the call. I further authorize BayFirst to contact me through the use of voice, voice mail and text messaging, including the use of pre-recorded or artificial voice messages and an automated dialing device. If necessary, I may change or remove any of the telephone numbers or email addresses at any time using any reasonable means to notify BayFirst. This consent updates any previous consent and further supersedes previous revocations of consent, if any, by me.

BySigning this form you are authorizing Front Street Advisors, Ltd. to use the information you have provided to fill out and submit your loan application to our banking partners and all the above information is true and agreed to:

Signature

Name and Title