FSC First Loan and Line of Credit Application

Please complete this loan application in full, and accurately. All loan submissions require 100% complete packages or they will not proceed to review or underwriting.

Application Type

Line of CreditLoan

How did you hear about FSC First?

Source Detail

Legal Business Name

Trade Name (Doing Business As)

Business Website

EIN #

Description of your Business

Business Phone

Mailing Street

Mailing City

Mailing State/Province

Mailing Zip/Postal Code

Is your business Physical Address the same as your Mailing Address?

Physical Street

Physical City

Physical State/Province

Physical Zip/Postal Code

Ownership

Primary Owner

First Name

Last Name

Title

Email

Business Phone

Mobile Phone

SSN/Tax ID

Gender

Race

Ethnicity

Military/Veteran Status

This data is collected for statistical purposes only. It has no bearing on the credit decision.

Birthdate

Country of Origin

Place of Birth

Are you a United States Citizen?

Lawful Permanent Resident Alien?

Resident Alien Registration #

Ownership %

%

Does this Principal have ownership in other business(es)?

Additional Business Owner(s)

100% of ownership must be accounted for. If the primary owner listed above does not have 100% ownership, then in the field below upload an attachment listing all owners, proprietor, partners, officers, directors, and all holders of outstanding stock. Please include % of Ownership, Name, title, Address, SSN, Date of Birth.

Number of Additional Owners

Upload other business ownership(s) as an attachment. Please include business name and % of ownership.

Personal Financial Statement as of Today's Date. The information should come from your completed statement that will be uploaded at the end of this application.

Total Personal Assets

$

Total Personal Liabilities

$

Disclosure of Interested Parties

During the loan underwriting process, FSC First may need to contact or be contacted by parties related to your business.

Please upload a document below that in includes: First and Last Name, Company, Title, Relationship to our business (i.e.: Attorney, Broker, Elected Official), Address, Phone, and email.

List of Interested Parties

***By completing this portion of the application, you are granting FSC First permission to discuss the status of the loan with these interested parties.

Proceeds

Create a new entry for each use

How do you plan to use the proceeds?

FSC First Contribution Amount

$

Owner(s) Contribution Amount

$

Other/Bank Contribution Amount

$

EPC

OC

Guarantors

Affiliates

Address of the subject property

Property Category

Property Category Other Description

Project cost breakdown including a breakdown of the fees

The square footage of the new location

What percentage will the OC occupy the subject property?

%

The square footage of their current location

When does their current lease expire?

Is the source of borrower's injection coming from business, personal, or both?

When is the anticipated close date?

Brief summary of the project and how the SBC will benefit from the project

Loan History

Loan History Explanation

SBA Application History

SBA Application History Explanation

Pending Lawsuit

Pending Lawsuit Explanation

Business Ownership Type

Business Indebtedness

List all business outstanding debts, contracts, notes, and mortgages payable. All debt listed should appear on financial statements.

Does your business hold any debt?

Create a new entry for each creditor Account

Creditor Account #

Original Debt Amount

$

Original Date

Outstanding Balance

$

Interest Rate

%

Maturity Date

Monthly Payment

$

Collateral

Current Status (Debt)

This will be paid by loan proceeds

Provide Statements

Upload a dated & signed personal financial statement.

Upload statements for each account listed above

Questionnaire

Are you subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought against you in any jurisdiction?

Criminal Charges Explanation

Have you been arrested in the past six months for any criminal offense?

Explanation of arrest

For any criminal offense-other than a minor vehicle violation-have you ever 1) been convicted; 2) plead guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgement)?

Criminal Conviction Explanation

Have you or any other owner of your company ever been involved in bankruptcy or insolvency proceedings?

Please provide bankruptcy details as an attachment

Are you, your owners, your business or affiliated entity involved in any pending lawsuits?

Please provide lawsuit details as an attachment

Does your business, its owners or majority stockholders own or have controlling interest in other businesses?

Please provide controlling interest details as an attachment

Do you buy from, sell to, or use the services of any concern in which someone in your company has a significant financial interest?

Please provide financial interest information as an attachment

Is your business a franchise?

Upload a copy of the franchise agreement and a copy of the disclosure statement supplied to you by the Franchisor.

Are your federal and local taxes current?

Please provide details about your taxes as an attachment

Summary of Collateral

Create a new entry for each collateral summary

Type of Collateral

Year Acquired

Original Cost

$

Market Value

$

Amount of Lien

$

Name of Lien Holder

Business Performance Financial Information

Please add data for the current year, two previous years, and 2 projected years (5 records total). For an existing business, use tax returns or financial statements. For start-up business, use projections.

Year

Total Income (tax return)/Gross Profit (P&L)

$

Total Expenses

$

Depreciation/Amortization

$

Interest

$

Supporting Documentation

Upload original or PDF of documents. Images or pictures of documents will not be accepted.

Upload U. S. Individual Tax Returns, with all attachments, for the past three (3) years FOR EACH individual and/or partner with 20% or more ownership stake in the business (signed). Include the most recent W-2.

Existing Business Only: Interim financial statements (Profit & Loss statement, Monthly Cash flow Statement and Balance Sheet) for the business (for the current year)

Existing Business Only: Historical financial statements (Profit & Loss statements, Monthly Cash flow Statements and Balance Sheets) for the past three (3) years

Projected Profit & Loss statements, Projected Balance Sheets and Projected Monthly Cash flow Statements covering a period of two (2) years following submission of the loan application supported with assumptions

A business plan including use of funds and plans for repayment for a start-up business or executive summary for an existing business

Last 3 months personal bank statements for all owners.

Last 3 months business bank statements.

Agreements and Certification

Agreement

All information in this application and in the attached exhibits, attachments, and addendums are true and complete to the best of my/our knowledge, information, and belief. I/we agree to pay for the cost of any surveys, title or mortgage examinations, credit reports, lien searches, attorney fees, appraisals, etc. and any subsequent fees that are necessary for consideration of this application and related to its receipt at FSC First.

Further, I/we agree not to engage in employment practices which deny equal employment rights to persons by reason of (i) political or religious opinion or affiliation, marital status, race, color, creed or national origin; (ii) sex or age, except when sex or age constitutes a bona fide occupational qualification; or (iii) physical or mental disability of a qualified individual with a disability. I/we agree to comply with the State’s policy of maintaining a drug and alcohol free workplace. I/We hereby authorize all involved in the financing of this

project to exchange freely without further authorization and consent, any and all financial information and reports provided in connection with this application and the processing of the loan request.

The undersigned agrees that banks, credit agencies, State agencies, IRS and other sources are hereby authorized now, or anytime in the future, to give FSC First, or their assigns and successors, any and all information in connection with matters addressed in this application, including information concerning the payment of taxes and credit information by the applicant.

The undersigned agrees to notify us immediately, and in writing of any change in name, address, or employment of any material adverse change (1) in any of the information contained in these statements or (2) in the financial condition of any of the undersigned or (3) in the ability of any other undersigned to perform its (or their) obligations to us. In the absence of such notice or a new and full written statement, this should be

considered as a continuing statement and substantially correct. If the undersigned fail(s) to notify us as required above, or if any of the information herein or in the statement should prove to be inaccurate or incomplete in any material respect, we may declare the indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable.

I understand that my signing constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided AND that I am authorized to submit this application on behalf of the Business and its Owners.

Full Name

Date

Additional Owner 1

Full Name of Additional Owner 1

Date

Additional Owner 2

Full Name of Additional Owner 2

Date

Additional Owner 3

Full Name of Additional Owner 3

Date

Photo, Video, & Print Release

I give my permission to the Prince George’s Financial Services Corporation (FSC First), its agents and employees, to print, publish, videotape, reproduce or otherwise use my name, photograph, or photographs, and any descriptive text regarding my participation in FSC First programs in a publication or publications to be disseminated publicly by FSC First to publicize and promote FSC First activities in Prince George’s County and the State of Maryland. In order to participate in this promotional effort, I hereby release and agree to hold harmless and indemnify FSC First from any and all rights, claims, or interest which I may have or which may arise as a result of FSC First’s publication of my name, photographic likeness (print, video or electronic), or other personal information for the purposes above-described, and I agree to hold harmless and indemnify FSC First from any and all claims concerning my participation in the promotional effort by third parties relating thereto.

Release Preference

I agreeI do not agree