Your Name:_______________________Business Name:______________________________
Address: ____________________________________________________________________
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Phone Number: (______)__________________ Fax Number: (______)___________________
Employer Identification Number (EIN): ____________________________________________
Number of Years in Business: ________ Loan Requested: _____________________________
What is the loan for? (Itemize any purchases and their costs)
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What can you offer for collateral or security on this loan? List the estimated
value of this
collateral and the method of evaluating its worth (appraisals, cost, depreciated
value).
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How does or will your organization or business benefit the community where you
operate? How
will this loan help?
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BUSINESS DESCRIPTION
Describe your business or business idea:
Who will own and operate the business? What will the business do? Where will
this business be
located? Why is this a good time to start or expand this business? How many
employees will this
business have? (Use additional sheets if necessary.)
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Describe your employees for the business: Number of jobs, full time/part time;
management /
administrative / skilled / unskilled.
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Describe your business facilities: (Include copies of any leases)
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Describe your suppliers.
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Describe the market for your product:
Who buys or will buy your service/product? Where are these customers? How will
you reach
them? What will you charge for your product? How has this been determined? How
will your
business grow? (Use additional sheets if necessary.)
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Describe your competition:
Who are they? What sets your service/ product apart from theirs? (Use additional
sheets if
necessary.)
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Provide a complete resume for all owners and managers of this business.
FINANCIAL INFORMATION
Loans are repaid by your business being profitable and returning cash through
the normal
business operating cycle. A financial history shows the past profitability of
this business.
Financial projectionsshow the future probability of the business. The HEAD Loan
Fund Staff
can assist you with compiling financial statements.
Existing Businesses or Buy-Outs:
Submit the most recent financial statements: tax returns, income statement
and balance sheet, along
with aged receivables, if receivables are significant and most recent inventory.
All Business:
Describe the cycle of your business. How long does it take from the
sale of the product or service
to the collection of the sale/fee?
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Submit financial projections for at least one year:
-Monthly Statements: Income statement and cash flow
-Annual Balances Sheet
List all significant financial assumptions such as:
-Number of sales per month
-Dollar amount of average sale
-Expenses incurred in the business, including but not limited to: slaries, rent,
telephone, utilities,
office costs, supplies, taxes, loan payments.
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Signature ....................................................................................................Date
PERSONAL FINANCIAL INFORMATION (CONTINUED)
1. List all your household expenses per month:
rent/mortgage $ ________________..................
_________________________ $ _____________
utilities ...........$________________..................._________________________
$ _____________
food ..............$ ________________.................._________________________
$ _____________
medical .........$ ________________..................._________________________
$ _____________
travel ............$ ________________..................
_________________________ $ _____________
2. Are you current on all personal or business tax liablities? If not, describe
in detail as to type,
whom payable, amount, property leins attached, and if there is a current work-out
strategy.
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3. Are you a cosigner on any other loans? If yes, describe.
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4. Have your ever been through a bankruptcy? Date of court approval.
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ASSET INFORMATION
1. Real Estate Owned:
Address type of property title is in name of date purchased original amount
present value
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2. Vehicle Owned:
Type of vehicle title is in name of VIN# Year Model
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3. Life Insurance Owned:
Name of company value of policy name of beneficiaries
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4. Stocks, bonds, pension plans, certificates of deposit:
Name of company or bank cost value and release dates
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The HEAD Corporation is authorized to make all inquiries deemed necessary to
verify the
accuracy of the statements made herein and to determine my/our creditworthiness.
______________________________________ ______ _________________________________
Signature of Applicant ........................................................ Signature of Co-applicant (if any)
______________________________________ ______
_________________________________
Social Security Number ...................................................... Social Security Number