Complete Legal Name of Business
Tax Payer Identification Number
Physical Address
City
State
Zip
Mailing Address
City
State
Zip
Business Telephone Number
 Business Fax Number
Website Address
This Business is a(n):
Corporation - C
Corporation - S
General Partnership
Individual
Limited Liability Corp.
Limited Partnership
Trust
Other

Kind of Business:
Retail
Wholesale
Mfg
Service
Hotel
Apartment
Other

Year Established:
Number of Employees:
Number of Owners/Managing Member:

Owners, Officers, or Partners Personal Data
Name of Owner
 Title
 D/O/B
 Social Security #
Ownership
%		 Active in Mgmt
Yes No
Home Address
City
 State
 Zip
 Drivers License
(State and Number)
Name of Owner
 Title
 D/O/B
 Social Security #
 Ownership
%		 Active in Mgmt
Yes No
Home Address
City
 State
 Zip
 Drivers License
(State and Number)
Name of Owner
 Title
 D/O/B
 Social Security #
 Ownership
%		 Active in Mgmt
Yes No
Home Address
City
 State
 Zip
 Drivers License
(State and Number)
Name of Owner
 Title
 D/O/B
 Social Security #
 Ownership
%		 Active in Mgmt
Yes No
Home Address
City
 State
 Zip
 Drivers License
(State and Number)

Has any owner entered into any contract on behalf of the business entity as 'guarantor'?
Yes No
Explain:
Are there any items below, pending against the business entity or any of its affiliates or owners?
Yes No a. Lawsuits
Yes No b. Judgments
Yes No  c. Forced Liens
Yes No d. Foreclosure Proceedings
Has the business or any of its affiliates or owners ever filed for bankruptcy?
Yes No
Explain:

Firm Name
Address
City
State
Zip
Contact Person
Telephone Number
E-Mail Address
Date Taxes Last Filed
Extensions Filed
No Yes 		If Yes What Year(s):

Bank Accounts
Bank Name
Address
City
State
Zip
Account Number Checking Account Savings Account Certificate of Deposit
Bank Name
Address
City
State
Zip
Account Number Checking Account Savings Account Certificate of Deposit
Bank Name
Address
City
State
Zip
Account Number Checking Account Savings Account Certificate of Deposit
Bank Name
Address
City
State
Zip
Account Number Checking Account Savings Account Certificate of Deposit

List All Fixed Obligations: Mortgages, Loans, Debts, and Landlord Including Leases on Equipment
Type of Debt Name Indebted to Account Number Date Incurred Original Amount Present Balance Monthly Payment

Name Telephone Address City State Zip

Insurance Information
Agent Name
 Address
 City
 State
 Zip
Contact Person
 Telephone Number
 E-Mail Address

AUTHORIZATION(S): The statements I've/we've made in this application are true. I/we agree to notify EZ Business Loans and the Lender of any important change in the facts This application now belongs to EZ Business Loans.
Signature
Printed Name		 S.S.# Date
Signature
Printed Name		 S.S.# Date
Signature
Printed Name		 S.S.# Date
Signature Printed Name S.S.# Date</