SBA Loan Borrower Information Form

SBA Loan Borrower Information Form

Please provide your details to proceed with your SBA loan application and answer a few questions related to life insurance. Life insurance is often a requirement for SBA loans.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemaleOther
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Credit Score?*
Bankruptcies within the last 7 years?*

YesNo
Do you have any felonies?*

YesNo
Resident Status*

I am US citizenNon US citizen or lawful permanent resident
List all partners with 20% or more ownership*
Do you have 20% or more ownership in any other entities?*

YesNo
Current Employment Status*
Requested Loan Amount (USD)*
What will you use funds for?*

Business AcquisitionBusiness Start-UpWorking CapitalReal Estate PurchaseDebt RefinancePartner Buy-Out
Life Insurance Questions (If Required by SBA)

This will help streamline the SBA process, in case life insurance is required to secure the loan.
Height (in feet and inches)*
Weight (in pounds)*
Do you use tobacco products?*

YesNo
Have you been diagnosed with any serious health conditions (e.g., heart disease, cancer, diabetes)?*

Heart DiseaseCancerDiabetesNone of the aboveOther
Do you currently have life insurance?*

YesNo
Have you ever been declined for life insurance?*

YesNo
Should be Empty:

Life Insurance Questions (If Required by SBA)