SMALL BUSINESS LOAN REQUEST FORM
Individual Name
Title
Company Name
Telephone
Address
Address
Street Address Line 2
City
State
Zip Code
Email
example@example.com
Type of Entity: Corp/Partnership/Proprietorship/Non-profit/LLC
Number of Employees Existing/ After Loan
Date Business Established
/
Month
/
Day
Year
Date
Business Tax ID Number
OWNERSHIP OF APPLICANT
COMPANY
List below all owners, co-owners, and stockholders of th
e business.
ESTIMATED PROJECT COSTS
Land Acquisition
New Building Construction
Land and building Acquisition
Building Improvements or repairs
Acquisition of Machinery Equipment
Inventory Purchase
Working Capital including accounts payable
Acquisition of a Business
Payoff bank loan
Other debt payment
Franchise Fee
Closing Costs approximately 5 of the loan amount
Cost Overrun Contingency usually 10 of the project cost as
TOTAL PROJECT AMOUNT
LESS OWN CASHEQUITY TO BE INJECTED
TOTAL LOAN REQUESTED FOR PROJECT
Applicant Signature
Date
/
Month
/
Day
Year
Date
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