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What is the Legal Structure of the Business?* Choose One:
Sole Proprietorship Partnership LLC Corporation
PLEASE NOTE: NON-PROFIT ORGANIZATIONS ARE NOT ELIGIBLE FOR SBA LOANS
What Product or Service does the Business sell?* Be specific.
Legal Name of Business* Do you do business under a different name?
Mailing Address of Business* City* State* Zip*
Location of Business
(if different from mailing address)		 City State Zip
Average Monthly Sales Average Annual Sales (last 3 yrs) Business Telephone* Business Fax*
The sales figures above are:* Best Contact:* Other Business Contact Number Email Address:*
Actual Sales* Projected Sales
Length of time business has been operating under current ownership? Industry Experience of Principal: Business Website Federal Tax ID Number
Yrs: Mnths: Yrs: Mnths:
PRINCIPAL AND GUARANTOR #1 - Percentage Ownership: Do you have ownership in any other companies or business?
%   Yes No If yes, % owned
Last Name* First Name* Middle Name* Date of Birth
Residence Address City State Zip
Renting? Own? Residence Telephone: Social Security Number
Yrs: Mnths: Yrs: Mnths:
Driver's License Number ( State and expiration date) My Total Liquid Assets/Cash in Banks
State: Expires on:  
PRINCIPAL AND GUARANTOR #2 - Percentage Ownership (If you are only a guarantor then ownership % is 0)
%      
Last Name First Name Middle Name Date of Birth
Residence Address City State Zip
Renting? Own? Residence Telephone: Social Security Number
Yrs: Months: Yrs: Months:
Driver's License Number ( State and expiration date) My Total Liquid Assets/Cash in Banks
State: Expires on:  
 

Electronic Signature of Principal/Guarantor Date
(s// john brown)

 Date  
 

Electronic Signature of Principal/Guarantor Date
(s// john brown)

 Date  
       
     
Applicant/Guarantor authorizes Lender/SBA and or Affiliates to investigate and confirm the information herein the SBA Express Business Loan Application and SBA  Express & Community Express Borrower Information Form(s), and hereby certifies that all information provided in conjunction with this application, including legal  status, is true, correct and complete. Applicant/Guarantor hereby authorizes Lender/SBA and or affiliates to utilize credit bureau/reporting agencies and or its own  agents for purposes of verifying the accuracy of any information provided by Applicant/Guarantor and for purposes of assessing and monitoring  applicants/guarantors credit status. Applicant/Guarantor authorizes that all credit bureau reporting agencies release any information they may have pertaining to  Applicant/Guarantor to Lender/SBA or Affiliates. This application may only be modified as approved in writing by an authorized officer of the Lender. No other  representative of Lender or affiliate is authorized to make any verbal or written modification to this application. By signing below Applicant/Guarantor represent that  the information presented within the SBA Express Business Loan Application and SBA Express & Community Express Borrower Information Form(s) is complete  and accurate, and that all loan proceeds will be used only for business related purposes. Applicant/Guarantor further understand that they are only eligible for SBA  guaranteed financing if they are unable to obtain the requested financing on similar terms and/or conditions elsewhere, and certify that they are unable to do so.  Applicant/Guarantor acknowledges and understands that the information provided on the application and supporting documents and/or correspondence must be  true and accurate. The penalty for knowingly making a false statement or overvaluing security to obtain a guaranteed loan from SBA is that you may be fined up to  $10,000 and/or be put in jail for up to 5 years under 18 USC §1001 and if submitted to a Federally insured institution, you may be fined up to $1,000,000 and/or be  put in jail for up to 20 years under 18 USC §1014.   IT Solutions Allscripts EHR Physicians eServices EHR Stimulus Breaking News