Businesses like yours are responsible for helping to keep the economy going by creating jobs and stimulating commerce. National Bank of Arizona is ready to help you assemble your application package for a business loan1 or a U.S. Small Business Administration loan1. When firms like yours succeed, we all succeed.
BUSINESS BANKING APPLICATION - SUPPLEMENTAL DATA - SBA
APPLICATIONNational Bank of Arizona Business Banking Application
BUSINESS INFORMATION Business plan, if available (required for start-ups)
Federal Tax Return: schedules, statements, K-1s (three years)2
Interim financial statement (no older than 60 days)
Accounts receivable and accounts payable agings (same date as business interim financial statement)
Lease or rental agreements on existing business location
24-month projected business income statement, cash flow,and balance sheet (for acquisition and start-up loans)
Prior government debt form (SBA loans only - form attached)
Revenue and affiliate statement (Form attached)
AFFILIATE INFORMATION (AS APPLICABLE)
Business debt scheduleFederal Tax Return: schedules, statements, K-1s (three years)2 Interim financial statement (no older than 60 days) Description of business operation
LEGAL ENTITY DOCUMENTATIONArticles of Incorporation and By-Laws Partnership agreementArticles of Organization and Operating Agreement Fictitious business name statementTrust agreement
PRINCIPAL/GUARANTOR INFORMATION(For those with a 20% of more ownership interest in the business)
Personal financial statement, less than 60 days old (form attached)Federal Tax Return (three years)2: schedules, statements, K-1s, W-2s (needed for outside income)Management profile/resume (form attached)
BUSINESS ACQUISITION/STOCK BUYOUT Purchase agreement with asset allocation
Business plan Business income projections with assumptions Seller tax returns (three years)2
Interim business financial statement (no older than 60 days)
REAL ESTATE LOANEnvironmental questionnaire (available from National Bank of Arizona) and any prior environmental reports
Owner occupancy: _____________%
For Purchase:Property description (include sq. ft.) Purchase agreement with counter offers
OTHER IF APPLICABLEFranchise agreement and Franchise Disclosure Document (FDD)Copy of note(s) to be refinanced
1Loans subject to approval; restrictions apply.2Two years for loans < $1,000,000. Three years for loans > $1,000,000 and all SBA loans.
Zions Bancorporation, N.A. dba National Bank of Arizona(“Bank”) requires financial information and documentation in addition to this application to review and underwrite a loan request. Supporting Information and documentation on the Business /Borrower and /or owners includes (but is not limited to) tax returns and/or financial statements on the business and personal guarantors.
Credit Request
Loan Type: Line of Credit Term Loan Letter of Credit Commercial Credit Card Lease ACH SBA Government Guaranteed Loan 504
Complete the following information for one individual with significant responsibility for managing the legal entity listed above, such as:
• An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, Treasurer); OR
• Any other individual who regularly performs similar functions.
Name: Address: Date of Birth (MM/DD/YYYY):
SSN1: Ownership %:
ID type: ID Number: State Issued: Date Issued: Exp. Date:
Role/Title in Business Applicant: Sole Owner Managing Member Partner CEO President Vice President Treasurer Other:
1) In lieu of a Social Security Number or passport number, Non-U.S. Persons may also provide an Individual Taxpayer Identification Number (ITIN), an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard.
Other Information
Is the Applicant, Owner, Joint Applicant, or Guarantor a U.S. Citizen? If “No”, provide copy of front and back of Alien Registration card. YES NO
Has the Business, Owner, Joint Applicant, or any Guarantor (1) filed for bankruptcy or defaulted on any debts, (2) been a party to, or the subject of, any litigation, lawsuits or other legal claims in the last 7 years, (3) defaulted under any loan or credit obligation with another lender, or (4) had a foreclosure, deed-in-lieu, or short sale within the last 4 years?
YES NO
Does the Applicant, Owner, Joint Applicant, or Guarantor owe any taxes for years prior to the current year or are any taxes currently past due by the Owner or Guarantor?
YES NO
Is the Applicant, Owner, Joint Applicant, or Guarantor a director, executive officer, or principal a shareholder of a financial institution? YES NO
Additional Notice and Acknowledgement Regarding this Business Loan Request
BUSINESS BANKING APPLICATION
The Business, Owner and person(s) signing below hereby (each, an “Applicant”): (1) certify that all information provided herein is true, correct and complete; (2) authorize the current and past creditors to release information to Bank regarding the creditworthiness of the Applicant and authorize Bank to check the credit history of the Applicant and verify the information with any source; (3) authorize Bank to obtain credit reports, including consumer credit reports, and other information about the Applicant (and if the Applicant is a sole proprietorship, consumer credit reports and employment history of the Owner’s spouse, if living in a community property state), in connection with this application or in connection with updates, renewals, extensions or from time to time until any credit granted as a result of this application is repaid in full and the credit has matured; (4) authorize Bank to report information about credit obtained in connection with this application to credit bureaus. Late payments, missed payments, or other defaults on credit obtained in connection with this application may be reflected in credit reports of the Applicant; (5) authorize Bank to release any and all financial and other information concerning the Applicant to (i) the United States Small Business Administration and/or Certified Development Companies, and (ii) to third parties as Bank desires in its sole discretion in connection with Bank’s consideration of the proposed credit transactions; (6)represent and warrant that the person(s) signing on behalf of the Business is/are duly authorized to execute this Business Banking Application and duly bind the Business and delivery of this Business Banking Application has been authorized by all necessary legal action by the Business and the Business will provide Bank written confirmation of such action upon request; (7) agrees that by providing a wireless telephone number(s) herein, the Applicant consents to receiving autodialed and prerecorded message calls and text messages from Bank or its third-party debt collector at the number(s) provided and confirm that the Applicant is/are the primary owner(s) of the number(s) and have the authority to provide this consent for the wireless number(s) provided; (8) an imaged or electronic facsimile or copy of the signatures of the Applicant may be used as evidence of the Applicant’s agreement to the terms of this Business Banking Application and I (i) waive any right to insist or require that Bank produce paper originals, (ii) agree that such images shall be accorded the same force and effect as the paper originals, (iii) agree that Bank is entitled to use such images in lieu of destroyed or archived originals for any purpose, including as admissible evidence in any demand, presentment or other proceedings, and (iv) further agree that any executed facsimile (faxed), scanned, or other imaged copy of this document or any document related to the credit applied for hereunder shallbe deemed to be of the same force and effect as the original manually executed document; (9) understand and agree that the credit applied for under this Business Banking Application may be used only for Business purposes; (10) understand the information provided in this Business Banking Application is made for the purpose of obtaining credit and any FALSE information may result in forfeiture of benefits and possible prosecution; (11)agree to provide such information and documentation as Bank may request during the term of the loan to confirm or update the continued accuracy of any information provided herein.
ADVERSE ACTION NOTICE: If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Business Banking Loan Center, 2460 South 3270 West, West Valley City, UT 84119 or call (888) 290-8509 within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.
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 (provided 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 this creditor is the Bureau of Consumer Financial Protection, 1700 G Street, NW, Washington, DC 20006
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT AND/OR APPLYING FOR A LOAN.
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 business entity and/or person who opens an account. What this means for you: When you open an account or apply for a loan, we will ask for your Federal Tax Identification Number, full legal name of your business, the physical address of your business; if you are an individual, we will ask for your full name, physical 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 that will aid in confirming this information.The Applicant agrees to promptly notify the Bank (A) of any change in direct or indirect ownership interests in the Applicant as reported in this Application, or (B) if the individual with significant managerial responsibility identified immediately below cease to have that responsibility, or if the information reported about that individual changes.
Business Applicant W-9 Request for Taxpayer Identification Number and Certification
BUSINESS BANKING APPLICATION
COMPLETE THIS SECTION ONLY IF YOU ARE A U.S. CITIZEN OR U.S. RESIDENT ALIEN. ALL OTHERS MUST COMPLETE A FORM W-8.
Check appropriate box for federal tax classification; check only one of the following seven (7) boxes:
Individual/Sole Proprietor or single-member LLC C Corporation S Corporation Partnership Trust/estate Other____________________
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ____________________
NOTE: For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.
NAME (as shown on your tax return): ________________________________________________
Business name/disregarded entity name, if different than above: __________________________
TIN (only one TIN may be provided)
SSN: - - OR EIN: -
UNDER PENALTIES OF PERJURY, I CERTIFY THAT:1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service
(IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longersubject to backup withholding, and
3. I am a U.S. citizen or other U.S. person, and4. I am exempt from FATCA reporting.
CERTIFICATION INSTRUCTIONS. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN.
____________________________________________ __________________________________________ ___________________Printed Name Signature Date
Additional Notice and Acknowledgement Regarding this Business Loan Request (Continued)
FOR BUSINESS ENTITY APPLICANTS:
Business Entity Applicant Name: _________________________________________
____________________________________________ __________________________________________ ___________________Authorized Officer – Printed Name & Title Authorized Officer – Signature Date
____________________________________________ __________________________________________ ___________________Authorized Officer – Printed Name & Title Authorized Officer – Signature Date
____________________________________________ __________________________________________ ___________________Authorized Officer – Printed Name & Title Authorized Officer – Signature Date
Business Guarantor or Business Co-Borrower Information (Business entities with a 20% or more direct or indirect ownership interest of the business applicant must complete the following section) Please complete additional sheets if needed.Business Applicant Legal Name or Owner’s name if Sole Proprietorship (as shown on tax return):
Business Applicant Taxpayer ID#: Doing Business As (if applicable)
Business Applicant Street Address (cannot be a P.O. Box) Check if home-based City State Zip Code
Business Mailing Address (if different than street address) City State Zip Code
Business Applicant Phone Number:
Date Business EstablishedMonth/Year:
Under Current Ownership Since Month/Year:
Business Location: Own Lease #Years:
Business Type: C Corp. S-Corp. LLC PLLC Partnership Limited Partnership Sole Proprietorship Trust Other:
Primary Contact: Best Contact Phone Number: Primary Contact Email: # of Employees: State of Business or DBA Filing:
Last Year’s Business Applicant Gross Annual Sales/Revenue:
Last Year’s Applicant Business Annual Net Income (before taxes):
Auto Debit? Yes No
Checking Account Number for Auto Debit: Average Checking/Savings Balances:
Business Guarantor Ownership Information (use additional sheet as necessary) Please provide complete list of ownership equal to 100%
Name Title % Ownership Guarantor Y/N
Yes No
Yes No
Yes No
Yes No
Business Guarantor or Business Co-Borrower Information (Business entities with a 20% or more direct or indirect ownership interest of the business applicant must complete the following section) Please complete additional sheets if needed.
Business Applicant Legal Name or Owner’s name if Sole Proprietorship (as shown on tax return):
Business Applicant Taxpayer ID#: Doing Business As (if applicable)
Business Applicant Street Address (cannot be a P.O. Box) Check if home-based City State Zip Code
Business Mailing Address (if different than street address) City State Zip Code
Business Applicant Phone Number:
Date Business EstablishedMonth/Year:
Under Current Ownership Since Month/Year:
Business Location: Own Lease #Years:
Business Type: C Corp. S-Corp. LLC PLLC Partnership Limited Partnership Sole Proprietorship Trust Other:
Primary Contact: Best Contact Phone Number: Primary Contact Email: # of Employees: State of Business or DBA Filing:
Last Year’s Business Applicant Gross Annual Sales/Revenue:
Last Year’s Applicant Business Annual Net Income (before taxes):
Auto Debit? Yes No
Checking Account Number for Auto Debit: Average Checking/Savings Balances:
Business Guarantor Ownership Information (use additional sheet as necessary) Please provide complete list of ownership equal to 100%
Name Title % Ownership Guarantor Y/N
Yes No
Yes No
Yes No
Yes No
BUSINESS BANKING APPLICATION
Role in this company (officer, manager, member, etc.)
Role in this company (officer, manager, member, etc.)
» All individuals with a 20% or more direct or indirect ownership interest of the applicant must complete and sign the following section.(Government Agencies and non-profit organizations are not required to complete the following section.)
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#4
Name of Personal Guarantor: Primary Phone Number: Social Security Number: Date of Birth (MM/DD/YYYY)
ID type: ID Number: State Issued: Date Issued: Exp. Date:
______ Ownership of Company: Sole Owner Managing Member Partner CEO President Vice President Treasurer Other:
Home Street Address (Cannot be a P O Box) City State Zip Code
*Gross Personal Annual Income includes any earned income related and unrelated to the business so long as it is not included in the business’ annual net profit. Alimony, child support, or separate maintenance income need not be disclosed if you do not wish to have it considered.
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#3
Name of Personal Guarantor: Primary Phone Number: Social Security Number: Date of Birth (MM/DD/YYYY)
ID type: ID Number: State Issued: Date Issued: Exp. Date:
______ Ownership of Company: Sole Owner Managing Member Partner CEO President Vice President Treasurer Other:
Home Street Address (Cannot be a P O Box) City State Zip Code
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#2
Name of Personal Guarantor: Primary Phone Number: Social Security Number: Date of Birth (MM/DD/YYYY)
ID type: ID Number: State Issued: Date Issued: Exp. Date:
______ Ownership of Company: Sole Owner Managing Member Partner CEO President Vice President Treasurer Other:
Home Street Address (Cannot be a P O Box) City State Zip Code
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#1
Name of Personal Guarantor: Primary Phone Number: Social Security Number: Date of Birth (MM/DD/YYYY)
ID type: ID Number: State Issued: Date Issued: Exp. Date:
______ Ownership of Company: Sole Owner Managing Member Partner CEO President Vice President Treasurer Other:
Home Street Address (Cannot be a P O Box) City State Zip Code
BUSINESS BANKING APPLICATION
By signing below, in my individual capacity (even if I place a title or other designation next to my signature), I (1) certify that all information I have provided on this Application or in connection herewith is true, correct and complete; (2) authorize my current and past creditors, employers, and consumer reporting agencies to release information to Bank regarding the request for the account(s) as indicated above; (3) agree that if I provided a wireless telephone number(s) herein, I consent to receiving autodialed and prerecorded message calls and text messages from the Bank or its third-party debt collector at that number and confirm that I have the authority to provide this consent for the wireless number provided; (4) authorize Bank to obtain credit reports, including consumer credit reports, and other information about me, in connection with this application or in connection with updates, renewals, extensions or from time to time until any credit granted as a result of this application is repaid in full and the credit has matured, and I understand and agree that Bank will obtain periodic follow-up credit reports on me from credit reporting agencies; (5) authorize Bank to release any and all financial and other information and documents concerning me, including such information and documents supplied to Bank by me and information about my credit and account experience with Bank, to (i) such third parties as Bank desires in its sole discretion in connection with Bank’s consideration of the proposed credit transactions, including but not limited to participant banks, and (ii) the United States Small Business Administration (“SBA”) and/or Certified Development Companies (“CDCs”), as deemed appropriate by Bank for any purpose related to the proposed credit transactions between bank and Applicant in which SBA or CDCs may participate; and (6) agree that an imaged or electronic facsimile or copy of my signature, in any capacity, may be used as evidence of acceptance of the terms hereof and I (i) waive any right to insist or require that Bank produce paper originals, (ii) agree that such images shall be accorded the same force and effect as the paper originals, (iii) agree that Bank is entitled to use such images in lieu of destroyed or archived originals for any purpose, including as admissible evidence in any demand, presentment or other proceedings, and (iv) further agree that any executed facsimile (faxed), scanned, or other imaged copy of this document or any document related to the credit applied for hereunder shall be deemed to be of the same force and effect as the original manually executed document.
___________________________________________ __________________________________________ ___________________ Guarantor #1 – Printed Name Guarantor – Signature Date
___________________________________________ __________________________________________ ___________________ Guarantor #2 – Printed Name Guarantor – Signature Date
___________________________________________ __________________________________________ ___________________ Guarantor #3 – Printed Name Guarantor – Signature Date
___________________________________________ __________________________________________ ___________________ Guarantor #4 – Printed Name Guarantor – Signature Date
All applicants applying for joint credit with Bank, such as the spouse applying for credit with his or her spouse or general partners, must sign the statement below to document their desire to be jointly liable for this loan with Applicant: The co-applicant(s) listed below do(es) hereby acknowledge, agree, and declare that, on this date, the co-applicant intend(s) to apply for joint credit with Applicant. The specific condition, terms, rates and fees associated with this loan have been discussed with the co-applicant and are represented in the disclosure documents provided to the co-applicant by the Bank.
___________________________________________ __________________________________________ ___________________Joint Applicant – Printed Name Joint Applicant – Signature Date
JOINT APPLICANT AUTHORIZATION AND ACKNOWLEDGMENT
By signing below, I (1) certify that all information provided herein is true, correct and complete; (2) authorize my current and past creditors, employers, consumer reporting agencies and any other reference listed above to release information to Bank regarding the credit applied for herein in this application or in connection with updates, renewals, extensions or from time to time until any credit granted as a result of this application is repaid in full and the credit has matured; (3) authorize Bank to report information about credit obtained in connection with this application to credit bureaus including late payments, missed payments, or other defaults on credit obtained in connection with this application may be reflected in credit reports of the Joint Applicant; (4) authorize Bank to release any and all financial and other information concerning the Joint Applicant to (i) the United States Small Business Administration and/or Certified Development Companies, and (ii) to third parties as Bank desires in its sole discretion in connection with Bank’s consideration of the proposed credit transactions; (5) agree that by providing a wireless telephone number(s) herein, I consent to receiving autodialed and prerecorded message calls and text messages from Bank or its third-party debt collector at the number(s) provided and confirm that the Joint Applicant is/are the primary owner(s) of the number(s) and have the authority to provide this consent for the wireless number(s) provided; (6) agree that an imaged or electronic facsimile or copy of the signatures of the Joint Applicant may be used as evidence of the Joint Applicant’s agreement to the terms of this Business Banking Application and I (i) waive any right to insist or require that Bank produce paper originals, (ii) agree that such images shall be accorded the same force and effect as the paper originals, (iii) agree that Bank is entitled to use such images in lieu of destroyed or archived originals for any purpose, including as admissible evidence in any demand, presentment or other proceedings, and (iv) further agree that any executed facsimile (faxed), scanned, or other imaged copy of this document or any document related to the credit applied for hereunder shall be deemed to be of the same force and effect as the original manually executed document; (8) understand and agree that the credit applied for under this Business Banking Application may be used only for Business purposes; (9) understand the information provided in this Business Banking Application is made for the purpose of obtaining credit and any FALSE information may result in forfeiture of benefits and possible prosecution.
___________________________________________ __________________________________________ ___________________Joint Applicant – Printed Name Joint Applicant – Signature Date
Joint Applicant Application
A Joint Applicant refers to an individual who applies with the applicant for shared or joint credit. It does not refer to someone whose signature is required by the creditor as a condition for granting the credit requested. A person’s intent to be a joint applicant must be evidenced at the time of application. The Equal Credit Opportunity Act requires a joint applicant to express intent to apply for joint credit. Signature(s) on a promissory note may not be used to show intent to apply for joint credit. Signatures on a credit application affirming applicants’ intent to apply for joint credit may be used to establish intent to apply for joint credit. The method used to establish intent must be distinct from the means used by individuals to affirm the accuracy of information. For example, signatures on a joint financial statement affirming the accuracy of information are not sufficient to establish intent to apply for joint credit.
Name of Individual Joint Applicant/Co-Borrower: Title: Ownership %:
Street Address (cannot be a P.O. Box): City State Zip Code Home Phone Number:
Tax ID or SSN: Date of Birth of Individual: Driver’s License/State ID #: State Issued: Expiration Date:
Individual Email Address: Gross Personal Annual Income*:
*Gross Personal Annual Income includes any earned income related and unrelated to the business so long as it is not included in the business’ annual net profit. Alimony, child support, or separate maintenance income need not be disclosed if you do not wish to have it considered.
NOTICE OF RIGHT TO APPRAISAL. The Bank may order an appraisal to determine the property’s value and charge you for this appraisal. We will give you a copy of any appraisal, even if your loan does not close. You can pay for an additional appraisal for your own use at your own cost.
MANAGEMENT PROFILE COMPLETE FOR EACH MANAGER (Please make copies, if necessary)
KEY MANAGER #2: Name, Title, Function
Date of birth Social Security Number
WORK EXPERIENCE (List chronologically beginning with present employment. Attached separate exhibit if necessary.)
Company Name Location
Duties Title Dates EmployedFrom: To:
Company Name Location
Duties Title Dates EmployedFrom: To:
Company Name Location
Duties Title Dates EmployedFrom: To:
EDUCATION
Name of College or Technical Training Location
Dates AttendedFrom: To:
Major Degree/Certificate
Name of College or Technical Training Location
Dates AttendedFrom: To:
Major Degree/Certificate
MILITARY SERVICE BACKGROUND
Branch From: To: Honorable Discharge? YES NO
Vietnam Veteran? YES NO
Rank at Discharge Major Assignment/Accomplishment
INFORMATION FOR GOVERNMENT STATISTICAL PURPOSES. (To be completed only if applying for an SBA loan.)
The following information is required by the U.S. Small Business Administration for all SBA business loan applications in order to reflect the participation of various groups in the SBA programs. Each OWNER of the business MUST provide the following information. Do NOT complete this section for key managers who are not owners of the business.
Indicatepercentage ownership
in the businessIndicate the owner’s gender
With which race does theowner most closely identify?
Choose one only.
Indicate owner’sveteran status
Does the owner considerhim/herself to be of Hispanic
origin? Choose one only.
______________% Male Female
African American Native American
(other than Eskimo or Aleut) Eskimo or Aleut Asian or Pacific Islander White Other
Non-Veteran Vietnam-Era Veteran Other Veteran
Not Spanish/Hispanic Puerto Rican Hispanic, other than
Puerto Rican
The Small Business Administration is committed to insuring that all SBA programs are made available to business owners of all races. Furthermore, SBA has specified certain groups to target assistance (such as exporters or veterans). Please provide the information requested above. Your compliance is voluntary and will not affect the credit decision. It does help SBA determine how well certain groups are being served. Thank you for your cooperation.
Project Costs Collateral Offered Present Market Value
Real Estate Acquisition $ Land $
New Construction/Expansion Repair $ Building $
Acquisition and/or Repair of Machinery and Equipment $ Machinery and Equipment $
Inventory Purchase $ Furniture $
Working Capital (including Loan Fees) $ Fixtures $
Acquisition of Existing Business $ Accounts Receivable $
Payoff SBA Loan $ Inventory $
Payoff Bank Loan (Non-SBA Associated) $ Residential Real Estate $
Other Debt Payment (Non-SBA Associated) $ Other $
TOTAL PROJECT $ TOTAL $
Equity CapitalInjection/Down Payment
$Source of Applicant’s Equity/Capital Injection
Loan Amount $
Repayment Terms - Years
FOR SBA LOAN APPLICANTS ONLY (Please complete for all business owners.)
Is the Applicant, Owner or Guarantor presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction?
YES NO
Has the Applicant, Owner or Guarantor been arrested in the past six months for any criminal offense? YES NO
For any criminal offense other than a minor vehicle violation, has the Applicant, Owner or Guarantor ever - (1) been convicted; (2) plead guilty; (3) plead nolo contendere; (4) been placed on pretrial diversion; or (5) been placed on any form of parole or probation (including probation before judgment)?
YES NO
If you are at least 50% or more owner of the Business, are you more than 60 days’ delinquent on any obligation to pay child support arising under an administrative order, court order, repayment agreement between the holder and a custodial parent, or repayment agreement between the holder and a state agency providing child support enforcement services?
YES NO
Is the Applicant, Owner or Guarantor employed by the U.S. Government? If yes, in what position/agency. YES NO
Does the Applicant, Owner or Guarantor, spouse or any member of the Applicant, Owner or Guarantor’s household, or anyone who owns, manages or directs your business (or their spouses or members of their households), work for the U.S. Small Busi-ness Administration, Small Business Advisory Council, SCORE, ACE, or any federal agency or the participating lender?
YES NO
Has an application for the loan you are applying for now ever been submitted to SBA or to a Certified Development Company or lender in connection with any SBA program?
YES NO
Is the Applicant, Owner or Guarantor presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded in this transaction by any Federal department or agency?
I do have personal or business affiliates as defined above, and have provided the required information.I do NOT have any personal or business affiliates as defined above, and have provided the required information.
____________________________________________________ __________________________ Signature (must be signed by the borrower) Date
____________________________________________________ __________________________ Name Title
AFFILIATES
WHAT IS AN AFFILIATE?Businesses that have common ownership, common management, or contractual relationships may be affiliates. The applicant, along with its affiliates, may be eligible under SBA’s size standards if the entire group as a unit is eligible using the size standard for the group’s primary industry. The applicant itself must also meet the size standard for its business. In order to determine eligibility an entity must provide three years of Tax Returns or the information requested on this form. The form must be signed by the applicant attesting to its accuracy.
Affiliate & Basis for Affiliation SIC/NAICS(optional)
2____Revenues
2____ #Employees
2____Revenues
2____ #Employees
2____Revenues
2____ #Employees
Name:
Nature of Business:
Common Ownership Common Management Contractual
$ $ $
Name:
Nature of Business:
Common Ownership Common Management Contractual
$ $ $
Name:
Nature of Business:
Common Ownership Common Management Contractual
$ $ $
Name:
Nature of Business:
Common Ownership Common Management Contractual
$ $ $
10-1-18 Zions Bancorporation, N.A. 1 of 3
CONFIDENTIALPERSONAL FINANCIAL STATEMENT
IMPORTANT INFORMATION ABOUT 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. When you open an account, we will ask 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.
INSTRUCTIONS: Please check all of the boxes that apply and complete the applicable information below. You are applying for individual unsecured credit and do not reside in a community property state or property that you own that is a basis for loan repayment is not located in a community property state. (If this box is checked, skip the remaining boxes and complete the financial statement below, except Section 2 which may be disregarded.)
The income or assets of your spouse will be used as a basis for loan qualification, or you are relying on alimony, child support, or separate maintenance payments from a spouse or former spouse as a basis for loan qualification. (If this box is checked, complete the financial statement below, including information about your spouse in Sections 2 and 3.)
You are married and (1) reside in a community property state, or (2) the property that will secure the loan is located in a community property state, or (3) other property that you own is located in a community property state and is a basis for loan repayment. (If this box is checked, complete the financial statement including the information about your spouse in Sections 2 and 3 and your spouse must sign this financial statement.)
Sole & Separate Obligation. You reside or own property in Arizona. This financial statement is submitted as a sole and separate financial statement to support a request for credit as a sole and separate debt of the undersigned (and is not based on the credit worthiness of the marital community, if any). All sole and separate income, assets and debts for which you are obligated are listed below. No information (except name) is provided for your spouse (if any).
None of the above boxed are checked. (The information in Section 2 may be omitted.)
Section 1 – Applicant Information Section 2 – Spouse Name Name
Address Address
City State ZipCode
City State ZipCode
How long at Present Address Yrs Mos How long at Present Address Yrs Mos
Social Security Number Date of Birthmm/dd/yyyy
Social Security Number Date of Birthmm/dd/yyyy
Position or Occupation Position or Occupation
Business Name Business Name
City State ZipCode
City State
Length of Employment Length of Employment
Res Phone Bus Phone Res Phone Bus Phone
Name of Nearest Relative Name of Nearest Relative
Address of Nearest Relative Address of Nearest Relative
Phone of Nearest Relative Phone of Nearest Relative
Section 3 – Statement of Financial Condition as of
Assets How Held* In Dollars Liabilities How
Held*Original Amount
Current Balance
Monthly Payment
Cash in Financial Inst. – See Sch G Notes payable to Banks & Fin Inst- See Sch. E
U.S. Govt & marketable securities – See Sch. A Credit Cards
IRA or Other Retirement Accounts – See Sch. B Amounts payable to others – secured
Accounts, loans, and notes receivable Amounts payable to others – unsecured
Real Estate – See Sch. C Real Estate Mortgages payable – See Sch. C
Automobiles Unpaid Income Tax
Other personal property Other unpaid taxes and Interest
Cash Surrender value of life ins. – See Sch. D Life Insurance Policy Loans
Loans Receivable Accounts and bills due
Other Assets itemize – Sch. F – if applicable Other debts (itemize on separate sheet)
Please attach separate list if needed Total Liabilities/Monthly Payments
Net Worth
Total Assets Total Liabilities and Net Worth
*A = Applicant’s Separate Property C = Community Property S = Spouse’s Separate Property (if spouse is co-applicant or guarantor) J = Other Jointly Owned
ZipCode
(Total Assets minus Total Liabilities)
10-1-18 Zions Bancorporation, N.A. 2 of 3
Section 4 – Schedules to Financial Statement
Schedule A – US Government & Marketable Securities
Number of Shares or Face Value of Bonds Description In Name of
Are These Required, Pledged/Held by Other?
Market Value Source of Value
Please attach separate list if needed Total To Section 3, line 2
Schedule B – IRA or other Retirement Accounts
Number of Shares Description In Name of Market Value Source of Value
Please attach separate list if needed Total To Section 3, line 3
Schedule C – Residences and Other Real Estate, including Equities (Partially or Wholly Owned)
Address & Type of Property
Title in Name of % of Owership Date Acquired Cost Market Value Mortgage Amount Mortgage Payment
Please attach separate list if needed Total To Section 3, line 5
Schedule D – Life Insurance Carried, Including Group Insurance
Name of Insurance Company Owner of Policy Beneficiary and Relationship Face Amount Policy Loans Cash Value
Please attach separate list if needed Total To Section 3, line 8
Schedule E – Bank and Other Institutional Borrowings
Name & Address of CreditorOriginal Loan Line Amount
Date of Loanmm/yy
Maturity Datemm/yy
Unsecured or Secured (List Collateral)
Amount Owed Payment Schedule
Please attach separate list if needed Total To Section 3, line 1
Schedule F – Business Ventures/Partnerships
Name & Address of Any Business You Are a Principal or Partner
Your Position & Title in the Business
Your % Ownership
Net Worth Business Listed in Section 3
Total Assets of Business
Line of Business & Years in Business Tax ID Number
Please attach separate list if needed
Schedule G – Cash in Banks, Credit Unions, Savings & Loans, etc.
Firm Branch Account Number Type Amount
Please attach separate list if needed To Section 3, line 1 Total
Yes No
Yes No
Yes No
Yes No
`
Outstanding Loans?
Section 5 – Source of Income
*Income from alimony, child support or separate maintenance payments need not be revealed unless you are relying on such as a basis for loan qualification. If you do not choose to disclose such income in applying for credit, as a creditor, we may inquire whether any income stated in an application is derived from such a source.
Base Salary Per Annum
Borrower Spouse
Bonus and Commissions
Dividends and Interest Income
Proprietorship (attach income statement)
Real Estate Income (Net)
Other Income (itemize below)*
*Itemized Other Income
Total
Payer Payment Type Amount
Section 6 – Additional Information
Contingent Liabilities Estimated Amounts
As Endorser? YES NO
Co-Maker or Guarantor? YES NO
On Lease? On Contract? YES NO
Involved in Pending Legal Action? YES NO
Other Special Debt/Circumstances? YES NO
Contested Income Tax Liens? YES NO
Are Any Assets Pledged? YES NO
Are You Obligated to Pay Alimony, Child Support or Maintenance? YES NO
Total Contingent Liabilities
Are Any Debts Past Due? YES NO
Have You Ever Had Any Auto, Furniture, or Other Property Repossessed? YES NO
Have You Filed for Bankruptcy? YES NO
Have You Applied for a Loan at Any Financial Institution in the Last Six Months? YES NO
If any of the above are yes, please explain:
The information contained in the statement is provided to induce the Lender to extend or to continue the extension of credit to the undersigned or to others upon the guaranty of the undersigned. The undersigned acknowledge and understand that the Lender is relying on the information provided herein in deciding to grant or continue credit or to accept a guaranty thereof. Each of the undersigned represents, warrants, and certifies that the information provided herein is true, correct, and complete. Each of the undersigned agrees to notify the Lender immediately and in writing of any change in name, address, or employment, and of any material adverse change (1) in any of the information contained in the statement, (2) in the financial condition of any of the undersigned, or (3) in the ability of the undersigned to perform its (or the) obligations to the Lender. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. The Lender is authorized to make all inquiries deemed necessary, including ordering consumer and business credit bureau reports, to verify the accuracy of the information contained herein, and to determine the credit-worthiness of the undersigned. Each of the undersigned authorizes the Lender to answer questions about the Lender's credit experience with the undersigned.
Signature (Individual) Date (mm/dd/yyyy)
Signature (Spouse) Date (mm/dd/yyyy) Verification by Non-Applicant Spouse (if applicable): I represent, warrant and certify to the best of my knowledge that the information contained in Sections 2 and 3 of this statement is true, correct and complete; I understand that the information in this statement is provided by the applicant to induce Lender to extend or continue the extension of credit to the applicant, and that the Lender will rely thereon. The Lender is authorized to make all inquiries deemed necessary, including ordering credit bureau reports, to verify the accuracy of the information contained herein. I am not, however, applying for individual credit.
Signature (Non-Applicant Spouse) Date (mm/dd/yyyy)
