Small Business Loan Request

Small Business Loan Request

Please print this form. After completion, submit it to your Vision Mortgage Company loan officer.

Steps

Checklist

Name __________________________________ As of Date ________________________________

Schedule of all Business Notes as of interim statement date, including wholesale plans on cars, mortgages, equipment leases, installment debts, lines of credit and other contractual obligations. Please indicate with an asterisk (*) any notes to be repaid from loan proceeds.

Account Number and to Whom Payable

Original Amount

Original Date

Balance Due

Interest Rate

Maturity Date

Monthly Payment P&I

Security

Status

How were proceeds used?

Lender:

Contact:

Phone:

Account #:

Lender:

Contact:

Phone:

Account #:

Lender:

Contact:

Phone:

Account #:

Lender:

Contact:

Phone:

Account #:

Lender:

Contact:

Phone:

Account #:

Lender:

Contact:

Phone:

Account #:

I/We authorize Vision Mortgage Company, Ltd. to make whatever credit inquiries it deems necessary in connection with a loan application. I/We authorize and instruct any person, trade reference, bank, and customer reporting agency to compile and furnish to Vision Mortgage Company, Ltd. any information that it may have or obtain in response to such credit inquiries and agree that such information, along with the application, shall remain Vision Mortgage Company, Ltd.'s property whether or not the loan application is approved.

Company Name __________________________________________ Date _____________________

Applicant Signature ________________________ Title _______________ Date _________________