Creative Business Financing Loan Application

Please enter as much information as possible. Shaded fields cannot be left blank.

If you are a broker filling out this application for a client, please
put your email address in the Applicants 'Email Address field.

          Broker Information:
Broker: 
Broker's Email: 
Phone Number: 
 

          Applicant Information:
Applicant's Name: 
Type of Business: 
Address: 
City: 
State: 
Zip Code: 
County: 
Phone Number: 
Fax Number: 
Email Address: 
 

          Loan Information:
Loan Amount Requested: 
Loan Type: 
Sources of Funds:
(Please list all sources,
including applicant's equity)
Borrowing Entity: 
Use of Proceeds: 
Exit Strategy: 
 

          Description of Property:
Property Address: 
City: 
State: 
Zip Code: 
County: 
Property Type:
(Land, Mix-Use Property
Office, etc...)
 

          Existing Debt:
Property Value: 
1st Mortgage Amount: 
Balance: 
Bank: 
2nd Mortgage ($): 
Balance: 
Bank: 
 

          Applicant's Attorney Information:
Name of Attorney: 
Address: 
City: 
State: 
Zip Code: 
Phone Number: 
Fax Number: 
Email Address: 
 

          Applicant's Accountant Information:
Name of Accountant: 
Address: 
City: 
State: 
Zip Code: 
Phone Number: 
Fax Number: 
Email Address: 
 

          Additional Information:
Have you ever filed for bankruptcy? 
 YesNo
(If yes, please explain.)
Have you ever been sued? 
 YesNo
(If yes, please explain.)
Do you have any pending litigation? 
 YesNo
(If yes, please explain.)
Are you current on all loan obligations? 
 YesNo
(If no, please explain.)