Vision Mortgage Company, Ltd.

Business Debt
Section 6 of 11
Small Business Loan Request
Please print this form. After completion, submit it to your Vision Mortgage Company loan officer.

Schedule of Business Debt

Name __________________________________ As of Date ________________________________

Schedule of all Business Notes as of interim statement date, including wholesale plans on cars, mortgages, equipment leases, installment debts, lines of credit and other contractual obligations. Please indicate with an asterisk (*) any notes to be repaid from loan proceeds.
Account Number and to Whom Payable Original Amount Original Date Balance Due Interest Rate Maturity Date Monthly Payment P&I Security Status How were proceeds used?
Lender:
Contact:
Phone:
Account #:
                 
Lender:
Contact:
Phone:
Account #:
                 
Lender:
Contact:
Phone:
Account #:
                 
Lender:
Contact:
Phone:
Account #:
                 
Lender:
Contact:
Phone:
Account #:
                 
Lender:
Contact:
Phone:
Account #:
                 
I/We authorize Vision Mortgage Company, Ltd. to make whatever credit inquiries it deems necessary in connection with a loan application. I/We authorize and instruct any person, trade reference, bank, and customer reporting agency to compile and furnish to Vision Mortgage Company, Ltd. any information that it may have or obtain in response to such credit inquiries and agree that such information, along with the application, shall remain Vision Mortgage Company, Ltd.'s property whether or not the loan application is approved.

Company Name __________________________________________ Date _____________________

Applicant Signature ________________________ Title _______________ Date _________________

Applicant Signature ________________________ Title _______________ Date _________________

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