Business Name
Contact Person
Annual Sales
Street Address
City
State
Zip Code
Mailing Address
Tax Identification Number
Cell Phone
Fax Number
Email
Applied to Bank of Whittier Before?
Describe Nature of Business
Industry
Legal Designation
Date Started Business
Duration of Current Ownership
Number of Employees
Loan Type
Loan Amount
Payable Over (in Years)
Loan Purpose
Collatoral Information
Additional Signers will sign at a later date
Full Name
Social Security Number
Percentage of Ownership
Primary Phone Number
Date of Birth
Time at Current Address
Residence Information
Monthly Income
Monthly Housing Payment
Total Assets (excluding value fo business)
Total Liabilities
Personal Net Worth
Identification Type
ID Number
Exp. Date
State Issued
Identification Type 2
Passport Number
Expiration Date
Country Issued
Military Identification Number
Card Type
Card Number
Bank Name
Address
Account Number
Account Type
Current Balance
To Whom Payable
Total Balance on Loan / Amount of Credit Line
Monthly Payment
Description of Collateral Pledged
Name of Supplier
Person to Contact
Telephone Number
Is the business currently involved in any litigation or other legal claims?
Has the business or any principal ever declared bankruptcy?
Are there any taxes currently past due by the business or any principal?
Is the company liable on any debts not shown above?
Is firm or principal contingently liable as guarantor or endorser?
