Business Loan Application

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General Information
Company Name
Address
Address (Cont.)
City
State

Zip

Soc Security Number
or Tax ID
Work Phone ( ) -
Year Founded Structure
Type of Business

Principal Officer(s)/Applicant(s) Information
Officer Name
Address
City
State

Zip

Title
Amount Owned
Social Security Number or Tax ID
Officer Name
Address
City
State

Zip

Title
Amount Owned
Social Security Number or Tax ID
Officer Name
Address
City
State

Zip

Title
Amount Owned
Social Security Number or Tax ID
Officer Name
Address
City
State

Zip

Title
Amount Owned
Social Security Number or Tax ID

 

Loan Information
Purpose of Loan
Use of Funds Land/Building $
  Equipment $
  Other $
Total Costs
Down payment or Borrower Equity
Collateral Description

Repayment Source
Current Banking Relationship
Proposed Banking Relationship
Date of Last Business
Financial Statement
Date of Last Personal Financial Statement

WARNING - Whoever knowingly makes any false statement, including overvaluation of any asset or omission of any liability in this or any other document in connection with any transaction with Heartland Bank, will be subject to a fine and/or imprisonment under provisions of the U.S. Criminal Code.

I/We understand and affirm the above statement and conditions and hereby authorize Heartland Bank to make what ever credit inquiries it deems necessary in connection with my credit application or in the course of review or collection of any credit extended in reliance of the application. I/We authorize and instruct any person or consumer reporting agency to compile and furnish Heartland Bank any information it may have or obtain in response to such credit inquiries.  I/We understand that I/We must furnish Heartland bank not less than annually current financial statement in connection with the above mentioned extension of credit.  Each of the above mentioned principles and applicants hereby warrants and represent to lender that the proceeds from this loan, if approved, will be used by the principals and applicants for business or commercial purposes and will not be used for personal, family, educational, or household purposes.

Loan Officer
If you are working with a loan officer, which one?

 


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