COMMERCIAL/AGRICULTURE LOAN APPLICATION - SUMMARY
You must be 18 years of age in order to submit information.
First
M

PILGRIM BANK

MEMBER FDIC


 Date
Last Telephone #
City Taxpayer I.D#
State Zip Nature of Business
Email Business Year End Date
Applicant's Name and Address
 
General Information
Legal Relationship: Corporation Partnership Sole-Proprietorship Other
Authorization Resolution Dated: Submitted with Statement On File With Creditor To Be Provided
Income Tax Return Filed Through What Date:
Name of Accountant or Accounting Firm:
Names of Persons Authorized to Borrow Money on Behalf of and in the Name of the Applicant:
1)
3)
2)
4)
Loan Request
Amount Requested
$
Secured
 Unsecured
Purpose of Loan
Initial Request
Additional Advance
Terms  
Financial Summery (see page 2 for explanation)
Financial Statement Submitted with this Summary
Current Financial Statement on File with Creditor
Assets
Current Assets
Account/Trade Receivables
Inventory - Gross
Fixed Assets
Other
Total Assets
 
Liabilities
Current Liabilities
Long Term Liabilities
Other Liabilities
Total Liabilities
Net Worth (Total Assets minus Total Liabilities)
Total Liabilities and Net Worth
Profit and Loss
Additional Information Requested
From
To
Net Sales
Gross Profit
Net Operating Profit
Net Profit/Loss
 
Equal Credit Opportunity Notice
Was your gross revenues $1,000,000 or less your previous fiscal 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:

PILGRIM BANK

MEMBER FDIC


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 this creditor is:

 

Dallas Regional Manager
Federal Deposit Insurance Corporation
1910 Pacifica Avenue, Suite 1900
Dallas Texas 75201

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 it's decision to grant such 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.