| 1st State Bank

1. Loan Request

Business must be located in Saginaw, Bay, or Midland County. Maximum Aggregate Credit Exposure $250,000. (Customers with existing loans at 1st State Bank please contact your Business Lender)

Loan Type*

Line of Credit ($150,000 max)
Equipment Loan ($250,000 max)
Real Estate Loan ($250,000 max)
Other ($250,000 max)

Line of Credit Dollar Value*

Please enter a number from 0 to 150000.

Equipment Dollar Value*

Please enter a number from 0 to 250000.

Real Estate Dollar Value*

Please enter a number from 0 to 250000.

Other Dollar Value*

Please enter a number from 0 to 250000.

Description/Purpose of Loan Request(s)*

Available Collateral

Accounts Receivable
Inventory
Equipment
Vehicle
Real Estate
Other

Other Collateral (Please Describe)

Accounts Receivable Dollar Value*

Inventory Dollar Value*

Equipment Dollar Value*

Vehicle Dollar Value*

Real Estate Dollar Value*

Other Collateral Dollar Value*

2. Business Information

Business Classification*

Sole Proprietorship
S-Corporation
C-Corporation
Partnership
Limited Liability (LLC/LLP)
Professional Corporation
Individual (Business)
Non-Profit

Business Name

Tax / Employee Identification Number*

Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Business Contact Name*

First Last

Business Contact Email*

Today's Date*

Date Business Established*

Present Management/ Ownership Since*

Recent Year-End Gross Revenue*

Recent Year-End Net Profit (Loss)*

3. Owners/Guarantors

List any individual who has 20% or more ownership or would be a guarantor of the loan.

Owner/ Guarantor Name #1*

First Last

Title*

Ownership Percentage*

SSN#/TIN#*

Date of Birth*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Owner/ Guarantor Name #2

First Last

Title

Ownership Percentage

SSN#/TIN#

Date of Birth

Phone

Address

Street Address Address Line 2 City State ZIP Code

Owner/ Guarantor Name #3

First Last

Title

Ownership Percentage

SSN#/TIN#

Date of Birth

Phone

Address

Street Address Address Line 2 City State ZIP Code

Owner/ Guarantor Name #4

First Last

Title

Ownership Percentage

SSN#/TIN#

Date of Birth

Phone

Address

Street Address Address Line 2 City State ZIP Code

4. Additional Information

Has the business incurred any loss in the last three years?*

Yes
No

Is the business, owners, or guarantors party to any claim, judgement, or lawsuit?*

Yes
No

Has the business, owners, or guarantors been involved in any bankruptcy proceedings?*

Yes
No

Are more than 20% of revenues from, or expenses to, a related entity?*

Yes
No

Is the business or any of its assets for sale or under agreement for sale?*

Yes
No

5. Certifications

A. If multiple applicants/ guarantors are joining in on this application, the undersigned intend to apply jointly as Borrowers and/or Guarantors of the loans for the company listed on the application, if applicable. The assets and income of each Borrower and Guarantor will be relied upon as a basis for the loan request.

B. Each undersigned (1) certifies that all information furnished and to be furnished in connection with this application is and will be true and complete, without omission of information, and fairly represents the financial condition of the Borrowers and/or Guarantors; and (2) grants connection with the application, including but not limited to business and personal credit reports.

C. 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 this creditor is FDIC Consumer Response Center, 1100 Walnut Street, Box #11, Kansas City, MO 64106.

6. Signatures

Company Name and Representative Signature

Company Legal Name*

Signature*

Title*

Owner/ Guarantor Name(s) and Signature(s)

Owner/ Guarantor Signature #1*

Print Name*

Owner/ Guarantor Signature #2

Print Name

Owner/ Guarantor Signature #3

Print Name

Owner/ Guarantor Signature #4

Print Name

Phone

This field is for validation purposes and should be left unchanged.

Business Loan Application

1. Loan Request

2. Business Information

3. Owners/Guarantors

4. Additional Information

5. Certifications

6. Signatures

Company Name and Representative Signature

Owner/ Guarantor Name(s) and Signature(s)