Freedom Bank - Business Loan Application


	User ID	Password

Business Loan Application

*Company or Business Name:

*Contact First Name:

*Contact Last Name:

Contact Title:

Street Address:

City:

State:

ZIP:

Phone Number:
- -

Taxpayer ID:

Year Established :

Nature of Business:

Annual Sales :

Number of Employees:

Business Structure:
Sole Proprietorship S-Corp C-Corp LLC Partnership Individual(s)

Other:


First Name:	Last Name:	Address:	Title:	% Ownership :
First Name:	Last Name:	Address:	Title:	% Ownership
First Name:	Last Name:	Address:	Title:	% Ownership :
First Name:	Last Name:	Address:	Title:	% Ownership :
First Name:	Last Name:	Address:	Title:	% Ownership :
First Name:	Last Name:	Address:	Title:	% Ownership :


Requested Loan Amount: $	Requested Number of Years for Term:
Purpose of Loan:
Source of Repayment:


	Purchase Price	Date Aquired (mm/dd/yyyy or you entered in an invalid date.)	Present Market Value	Amount Owed
Land & Buildings ------------------------------------
Furniture & Equipment ---------------------------
Accounts Receivable ------------------------------
Inventory ------------------------------------------------
Personal Residence --------------------------------
Other:


First Name:	Last Name:	Address:
First Name:	Last Name:	Address:
First Name:	Last Name:	Address:
First Name:	Last Name:	Address:
First Name:	Last Name:	Address:
First Name:	Last Name:	Address:


Is Freedom Bank your Primary Bank?:	Yes No If yes, Account Num:
Other Banking Relationships:
Bank Name:	Address:	Account type :	Current Balance :
Bank Name:	Address:	Account type :	Current Balance :
Bank Name:	Address:	Account type :	Current Balance :
Bank Name:	Address:	Account type :	Current Balance :


Has the business or any owner, principal or guarantor ever filed bankruptcy or defaulted on any debt?	Yes No
Is the business or any owner, principal or guarantor a party to a claim or a lawsuit?	Yes No
Are there any assets pledged or mortgaged that are not listed in the business or personal financial statements?	Yes No
(if you answered "Yes" to any of the above questions, please provide the details with an attachment)

By signing below, the applicant(s) certifies that he/she has the authority to sign; that all the information contained in this application is true; that the applicant has retained a copy of this application; that, if loan is approved, applicant will submit copies of all tax returns and a current financial statement annually; that Freedom Bank is authorized to check the credit rating of the business and each owner or principal associated with it; that all loan proceeds from this loan request will be used for business purposes and not for personal, family or household use; and that this original application will remain the property of Freedom Bank.

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 Freedom Bank at PO Box 2076, Columbia Falls, MT 55912 or call (406) 892-1776 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.

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 the creditor is: FDIC Consumer Response Center, 2345 Grand Blvd, Suite 100, Kansas City, MO 64108.

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