Commercial Business Loan Application

Entity Information

• Legal Entity *
• Entity's Taxpayer ID *
• Address *
• City *
• State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip *
• Business Type
  Corporation Partnership Sole-Proprietorship Other
• Authorized Resolution Dated *
• Authorized Resolution Type
  Submitted with Statement On File With Creditor To Be Provided
• Income Tax Refund Filed Through What Date *
• Are there any returns being contested or audited? *

  Yes No
• Name of Accountant or Accounting Firm *
• Name(s) of Persons Authorized to Borrow Money On Behalf of and in the Name of the Applicant*
• Nature of Business *
• Business Year End Date *

Owner/Member Information

• Same as Entity
• Name *
• Taxpayer ID *
• Address *
• City *
• State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip *
• Date of Birth *
• Email *
• Phone *

Loan Request

• Amount Requested ($)*
• Loan Type
  Secured Unsecured Initial Request Additional Advance
• Purpose of Loan*

Loan Request

• Status of Financial Statement *

  Financial Statement Submitted with this Summary Current Financial Statement on File with Fowler State Bank

Assets

• Current Assets*
• Account/Trade Receivables*
• Inventory - Gross*
• Fixed Assets*
• Other*
• Total Assets*

Liabilities

• Current Liabilities*
• Long-Term Liabilities*
• Other Liabilities*
• Total Liabilities*
• Net Worth*
• Total Liabilities and Net Worth*

Profit and Loss

• From (Date)*
• To (Date)*
• Net Sales*
• Gross Profit*
• Net Operating Profit*
• Net Profit/Loss*

Equal Credit Opportunity Notice

• Were your gross revenues $1,000,000 or less in your previous fiscal year? *

  Yes No

If you answered "yes" and the creditor denies your application for credit, you have the right to a written statement of the specific reasons for denial. To obtain the statement please contact:
COMMERCIAL LOAN DEPT.
FOWLER STATE BANK
300 E 5TH STREET
FOWLER, INDIANA 47944
(765)-884-1200
within 60 days from the date you are notified of the Creditor's decision. The Creditor will send you a written statement of reasons for the denial within 30 days of recieving your request for the statement.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (providing the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public income assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act, the federal agency that administers compliance with this law concerning this creditor is:
FDIC CONSUMER RESPONSE CENTER
1100 WALNUT STREET
BOX #11 KANSAS CITY, MO 64106

The signer(s) certify that all information provided above is a complete and true statement of the financial condition of the undersigned individuals on the date indicated. The signer(s) authorizes Fowler State Bank ("Bank") to obtain consumer and/or business reports in their names as individuals at any time and to verify all portions of this financial statement, including all financial statements and federal tax returns, with appropriate sources. The Bank is also authorized to provide credit information about the signer(s) to other creditors and credit reporting agencies. The signer(s) also agrees to provide any further information the Bank may require to process this application.

• Applicant Signature *
• Date *

• Joint Applicant Signature
• Date
• Joint Applicant Signature
• Date
• Joint Applicant Signature
• Date

• Co-Applicant Signature *
• Date *
• Bank Representative