Microlending

How much money do you need to borrow?

(Micro Loan Program limited to $10,000 per business)

How much of your own money are you putting into the transaction?

How will you use the borrowed money?

Real Estate

Leasehold Imprv

Construction

Renovation

Total

Operations

Equipment

Furn/Fixtures

Inventory

Accts Rec

Total

Various

Buy a Business

Façade Imprv

R&D

Professional Fees

Start-up costs

(Itemize details below)

Total

General Comments:

Small Business Loan Center Application

Important Application Information: Federal Law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

Each shareholder, partner or member owning 25 percent or more interest in the Business Applicant must sign a personal guaranty. A minimum of 1 guarantor is required regardless of percent ownership. Additional guaranties may be required.

BUSINESS INFORMATION

Business Applicant's Name (Exact Legal Name)

First Middle Last

DBA (If Applicable)

Business Street Address (Can not be a PO Box)

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address (If Different From Above)

Street Address City State / Province / Region ZIP / Postal Code

Tax Payer ID Number

Business Type

Sole Proprietorship

C-Corporation

S-Corporation

Limited Liability Company

Partnership

Other

Business Phone

Business Fax

Cell Phone

Description of Business or Service (Be Specific)

Date Business Stated

Years Current Ownership

Years Owners Have Been in This Line of Business

Number of Employees

Gross Annual Sales in Your Previous Fiscal Year

Business Year End Date

Business Checking & Savings Total Balance

OWNER(S) INFORMATION

List all Owners/Guarantors with at least 25% ownership interest in the company.

Authorized Officer

First Middle Last

Social Security Number

Date of Birth

Title

% of Ownership

Years as Owner

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Monthly Mortgage/Rent Payment

Gross Personal Annual Income as Reported on Last Tax Return

Net Worth (Excluding the Business)

Cash & Marketable Securities

Authorized Officer

First Middle Last

Social Security Number

Date of Birth

Title

% of Ownership

Years as Owner

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Monthly Mortgage/Rent Payment

Gross Personal Annual Income as Reported on Last Tax Return

Net Worth (Excluding the Business)

Cash & Marketable Securities

Do you have more than two Owners/Guarantors with at least 25% ownership in the company?

Yes

No

Authorized Officer

First Middle Last

Social Security Number

Date of Birth

Title

% of Ownership

Years as Owner

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Monthly Mortgage/Rent Payment

Gross Personal Annual Income as Reported on Last Tax Return

Net Worth (Excluding the Business)

Cash & Marketable Securities

Authorized Officer

First Middle Last

Social Security Number

Date of Birth

Title

% of Ownership

Years as Owner

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

Monthly Mortgage/Rent Payment

Gross Personal Annual Income as Reported on Last Tax Return

Net Worth (Excluding the Business)

Cash & Marketable Securities

LOAN REQUEST

Purpose of Loan

Loan Type

Amount Request

Term Requested

Collateral Available

FINANCIAL INFORMATION

Untitled

CORPORATE TAX RETURNS OR FYE STATEMENTS FOR LAST TWO YEARS AND INTERIM, IF AVAILABLE SUBMITTED WITH THIS APPLICATION.

CURRENT PERSONAL FINANCIAL STATEMENT AND MOST RECENT PERSONAL TAX RETURN SUBMITTED WITH THIS APPLICATION.

BUSINESS DEPOSIT ACCOUNTS

Financial Institution

Type of Account

Current Balance

Average Balance

Financial Institution

Type of Account

Current Balance

Average Balance

Financial Institution

Type of Account

Current Balance

Average Balance

PERSONAL DEPOSIT ACCOUNTS

Financial Institution

Type of Account

Current Balance

Average Balance

Financial Institution

Type of Account

Current Balance

Average Balance

Financial Institution

Type of Account

Current Balance

Average Balance

BUSINESS DEBTS (List all debts including accounts and trade payables)

To Whom Payable?

Type of Account (Revolving, Term, etc.)

Balance Owing

Payment

Pay Off with Proceeds?

Yes

To Whom Payable?

Type of Account (Revolving, Term, etc.)

Balance Owing

Payment

Pay Off with Proceeds?

Yes

To Whom Payable?

Type of Account (Revolving, Term, etc.)

Balance Owing

Payment

Pay Off with Proceeds?

Yes

RELATED BUSINESS ISSUES

Has the applicant or any guarantor or co-applicant ever declared bankruptcy?

Yes

No

Is the business applicant or any guarantor or co-applicant a party to any claim or lawsuit?

Yes

No

Are there any state or federal tax liens filed against the business applicant or any guarantor or co-applicant?

Yes

No

EQUAL CREDIT OPPORTUNITY NOTICE

Were your gross revenues $1,000,000 or less in your previous 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 the denial. To obtain the statement, please contact:

First Financial Bank Business Banking 225 Pictoria Drive Cincinnati, OH 45246 (888) 815-3530

within 60 days from the date you are notified of Creditor’s decision. The Creditor will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. The notice at right describes additional protections extended to you.

NOTICE: 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 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 the creditor is:

Federal Reserve Consumer Help Center P.O. Box 1200 Minneapolis, MN 55480 (888) 851-1920 (8 a.m. to 6 p.m. CST)

Untitled

NOTICE - Applicant Only

NOTICE - JOINT CREDIT with Co-Applicant(s)

We intend to apply for joint credit. (Initials)

(If applicable, complete the Statement of Intent form.)

This information and the information provided on all accompanying financial statements and schedules is provided for the purpose of obtaining credit for the Applicant(s) or for the purpose of Applicant(s) guaranteeing credit for others. Applicant(s) acknowledge that representations made in this statement will be relied on by Creditor in its decision to grant such credit. This Statement is true and correct in every detail and accurately represents the financial condition of the Applicant(s) on the date given below. Creditor is authorized to make all inquiries it deems necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the Applicant(s). Applicant(s) will promptly notify Creditor of any subsequent changes which would affect the accuracy of this Statement. Creditor is further authorized to answer any questions about Creditor’s credit experience with Applicant(s). Applicant(s) are aware that any knowing or willful false statements regarding the value of the above property for purposes of influencing the actions of Creditor can be a violation of federal law, 18 U.S.C. & 1014, and may result in a fine or imprisonment or both.

In addition, each individual signing below authorizes the Creditor to check their individual credit account and employment history and have a credit reporting agency prepare a consumer credit report on them.

Please type your digital signature below (full name):*

Today's Date*

Email

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Small business loans up to $10,000

Apply For A Microloan

Ready to Apply?

How will you use the borrowed money?

Real Estate

Operations

Various

Management:

Personal Financial Information

Assets

Liabilities

Small Business Loan Center Application

BUSINESS INFORMATION

OWNER(S) INFORMATION

LOAN REQUEST

FINANCIAL INFORMATION

RELATED BUSINESS ISSUES

EQUAL CREDIT OPPORTUNITY NOTICE

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