Vision Mortgage Company, Ltd.

Loan Request
Section 1 of 11
Small Business Loan Request
Please print this form. After completion, submit it to your Vision Mortgage Company loan officer.

Applicant Company

Principal's Name _______________________________________ Title ____________________________

Second Contact Name ___________________________________ Title ___________________________

Company Name _______________________________________________________________________

Address _________________________________________ Telephone (business) ___________________

Telephone (home) _________________ Facsimile ___________________ E-Mail: ___________________

City ________________________ County ____________________ State __________ Zip _____________

Type of Entity:

Corporation (S Corp or C Corp) Partnership (General or Ltd.) Sole Proprietorship L.L.C.

Number of Employees: Existing _______________ After Loan _______________

Date Business Established: ______________________ Tax ID# ____________________________

Ownership and Management of Applicant Company

List below all owners, co-owners, and all stockholders of the company. (100% ownership should be indicated.)

Name ____________________________________ Title ________________ % of Ownership __________

Name ____________________________________ Title ________________ % of Ownership __________

Name ____________________________________ Title ________________ % of Ownership __________

Name ____________________________________ Title ________________ % of Ownership __________

Affiliates

List below all business concerns in which the applicant company or any of the individuals listed in the ownership section above have ownership.

Company Name __________________________ Owner _________________ % of Ownership _________

Company Name __________________________ Owner _________________ % of Ownership _________

Company Name __________________________ Owner _________________ % of Ownership _________

Company Name __________________________ Owner _________________ % of Ownership _________

Use of Loan Proceeds

Real estate acquisition $__________________
New building construction $__________________
Building/Leasehold improvements or repairs $__________________
Acquisition of machinery or equipment $__________________
Inventory purchase $__________________
Acquisition of existing business $__________________
Debt refinancing $__________________
Payment of accounts payable $__________________
Working capital $__________________
Other $__________________
Total Project Costs $__________________
Less: Down Payment $__________________
Requested Loan Amount $__________________
   
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