Application - Business Loan


Only Complete Applications will be accepted
* = Required Fields
  

Please tell us about yourself:

*Business Name (exact legal name)

DBA (if applicable)

*Business Street Address

Address (cont.)

*City

*State

Zip/Postal Code

County

   

Current Mailing Address
(if different than Business Street Address)

Address (cont.)

City

State

Zip/Postal Code

County

   

Primary Business Contact

Phone Number

Fax Number

E-mail Address

   

Secondary Business Contact

Phone Number

Fax Number

E-mail Address

   

Specify Business Type:

Other

*Tax Payer ID Number:

Business Establishment Date:

(mm/dd/yyyy)

*Years Under Current Ownership

Please provide a brief description of the business activity you engage in:


 

Ownership:  (List up to 5 using this application)

#1

 

Name (list all current owners)

Social Security #

Date of Birth

(mm/dd/yyyy)

Title (if applicable)

Owner Percentage

%

Number of years in this line of business

 

#2

 

Name (list all current owners)

Social Security #

Date of Birth

(mm/dd/yyyy)

Title (if applicable)

Owner Percentage

%

Number of years in this line of business

 

#3

 

Name (list all current owners)

Social Security #

Date of Birth

(mm/dd/yyyy)

Title (if applicable)

Owner Percentage

%

Number of years in this line of business

 

   

#4

 

Name (list all current owners)

Social Security #

Date of Birth

(mm/dd/yyyy)

Title (if applicable)

Owner Percentage

%

Number of years in this line of business

 

#5

 

Name (list all current owners)

Social Security #

Date of Birth

(mm/dd/yyyy)

Title (if applicable)

Owner Percentage

%

Number of years in this line of business

 

   
 
 

Financial Information (List up to 5 Deposit Accounts using this application)
Business Deposit Accounts

#1

 

Financial Institution
(Business Deposit Account)

Type of Account

Current Balance

$

Average Balance

$

Are you proposing to move the account to BNC?

Yes No

   

#2

 

Financial Institution
(Business Deposit Account)

Type of Account

Current Balance

$

Average Balance

$

Are you proposing to move the
account to BNC?

Yes No

   

#3

 

Financial Institution
(Business Deposit Account)

Type of Account

Current Balance

$

Average Balance

$

Are you proposing to move the account to BNC?

Yes No

   

#4

 

Financial Institution
(Business Deposit Account)

Type of Account

Current Balance

$

Average Balance

$

Are you proposing to move the account to BNC?

Yes No

   

#5

 

Financial Institution
(Business Deposit Account)

Type of Account

Current Balance

$

Average Balance

$

Are you proposing to move the account to BNC?

Yes No

   

Financial Information (List up to 5 Accounts using this application)
Business Debts

#1

 

Financial Institution 
(Business Deposit Account)

Type of Account
(revolving, term,etc..)

Current Balance Owed

$

Payment

$ per months
 

Pay off with proceeds from the business loan you are applying for?

Yes No

   

#2

 

Financial Institution
(Business Deposit Account)

Type of Account
(revolving, term,etc..)

Current Balance Owed

$

Payment

$ per months
 

Pay off with proceeds from the business loan you are applying for?

Yes No

   

#3

 

Financial Institution
(Business Deposit Account)

Type of Account
(revolving, term,etc..)

Current Balance Owed

$

Payment

$ per months
 

Pay off with proceeds from the business loan you are applying for?

Yes No

   

#4

 

Financial Institution
(Business Deposit Account)

Type of Account
(revolving, term,etc..)

Current Balance Owed

$

Payment

$ per months
 

Pay off with proceeds from the business loan you are applying for?

Yes No

   

#5

 

Financial Institution
(Business Deposit Account)

Type of Account
(revolving, term,etc..)

Current Balance Owed

$

Payment

$ per months
 

Pay off with proceeds from the business loan you are applying for?

Yes No

   
 

Credit References (Please provide at least 3 credit references)

#1

 

Financial Institution

Contact Name

Phone Number

Type of Account
(revolving, term,etc..)

 

Is the loan presently current in all payments?

Yes No

 

Has the loan been historically past due?

Yes No

   

#2

 

Financial Institution

Contact Name

Phone Number

Type of Account
(revolving, term,etc..)

 

Is the loan presently current in all payments?

Yes No

 

Has the loan been historically past due?

Yes No

   

#3

 

Financial Institution

Contact Name

Phone Number

Type of Account
(revolving, term,etc..)

 

Is the loan presently current in all payments?

Yes No

 

Has the loan been historically past due?

Yes No

   

#4

 

Financial Institution

Contact Name

Phone Number

Type of Account
(revolving, term,etc..)

 

Is the loan presently current in all payments?

Yes No

 

Has the loan been historically past due?

Yes No

   

#5

 

Financial Institution

Contact Name

Phone Number

Type of Account
(revolving, term,etc..)

 

Is the loan presently current in all payments?

Yes No

 

Has the loan been historically past due?

Yes No

   
 

Loan Request #1

Requested Loan Amount

$

Requested Loan Term

months

Requested Interest Rate

%

Requested Payment Amount

$ per

Loan Type Requested

 

Purpose of the Loan

Other

Available Collateral:
(may choose more than one)

Accounts Receivable

Equipment

 

Building

Inventory

 

Crops

Raw Land

 

Cash / C.D.

Livestock

 

Leaseholds

Publicly-Traded Stock

 

Titled Vehicles

Fixtures

Other

   

Loan Request #2

Requested Loan Amount

$

Requested Loan Term

months

Requested Interest Rate

%

Requested Payment Amount

$ per

Loan Type Requested

Purpose of the Loan

Other

Available Collateral:
(may choose more than one)

Accounts Receivable

Equipment

 

Building

Inventory

 

Crops

Raw Land

 

Cash / C.D.

Livestock

 

Leaseholds

Publicly-Traded Stock

 

Titled Vehicles

Fixtures

Other

   

Loan Request #3

Requested Loan Amount

$

Requested Loan Term

months

Requested Interest Rate

%

Requested Payment Amount

$ per

Loan Type Requested

Purpose of the Loan

Other

Available Collateral:
(may choose more than one)

Accounts Receivable

Equipment

 

Building

Inventory

 

Crops

Raw Land

 

Cash / C.D.

Livestock

 

Leaseholds

Publicly-Traded Stock

 

Titled Vehicles

Fixtures

Other

   

Please answer the following questions:

Has the business or any owner ever declared bankruptcy? Yes No

If Yes, please describe:

   

Is the business or any owner currently party to any claim or lawsuit? Yes No

If Yes, please describe:

 

Are there any tax liens filed against the business or any owner? Yes No

If Yes, please describe:

   

Please provide any other information you feel is pertinent to the loan transaction:


   
   

Please read the terms below..... Click on Submit at the end of the documents to complete the application.  By submitting this application, all terms are accepted by the customer. 

I/We represent that this application is complete and accurate and fully reflects my/our financial condition on the date shown below.  I/We agree to notify Lender immediately, in writing, of any adverse change in my/our financial condition.  I/we understand that Lender will retain this Application whether or not it is approved.

INFORMATION DISCLOSURE AUTHORIZATION

To Whom it May Concern: 

I/We hereby authorize you to release to BNC National Bank its successors and/or assigns, for verification purposes, information concerning:

[ X ] Employment history, dates, title, income, hours worked, etc…

[ X ] Checking, savings, and investment accounts (including copies of statements, etc.).

[ X ] Mortgage/Consumer/Business loan rating, (opening date, high credit, payment amount, loan balance, and payment record).

[ X ] Personal and business records from accountants, attorneys, etc… that may have information required for the processing of a loan.

 [ X ] Any information deemed necessary in connection with a credit report for a mortgage/consumer/business loan transaction.

The information is for the confidential use of the lender in determining my/our creditworthiness for a mortgage/consumer/business purpose loan.

A PHOTOGRAPHIC COPY of the under sign's authorization MAY BE DEEMED TO BE THE EQUIVALENT OF THE ORIGINAL and MAY BE USED AS A DUPLICATE ORIGINAL.  The original signed form is maintained in the BNC NATIONAL BANK, 322 EAST MAIN, BISMARCK, ND 58501 OFFICE.

Your prompt reply will help my/our loan transaction.


Important Information

Procedures for opening a New Account
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

What this means for you:
When you open an account, we will ask you for your name, address, date of birth, and other information that will allow us to identify you.  We may also ask to see your driver's license or other identifying documents.

Credit Disclosure Statement
Borrowers of BNC National Bank are not required to obtain insurance from a particular insurance company. Any insurance required as a condition of the extension of credit by BNC National Bank may, without affecting approval of the application for an extension of credit, be purchased from an insurance company of the Borrower's choice.


PRIVACY STATEMENT - Printable Copy

 

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