112 WEST KING STREET, STRASBURG, VIRGINIA 22657

COMMERCIAL LOAN APPLICATION

FINANCIAL DOCUMENT CHECKLIST

FOR THIS LOAN REQUEST TO BE CONSIDERED COMPLETE, THE FOLLOWING DOCUMENTS NEED TO ACCOMPANY THE SIGNED
APPLICATION:

 BUSINESS FISCAL YEAR END FINANCIAL STATEMENTS FOR THE LAST TWO YEARS. YOU MAY PROVIDE EITHER:
1. CPA PREPARED FINANCIAL STATEMENTS (compiled/reviewed/audited) COMPLETE WITH INCOME STATEMENTS AND BALANCE
SHEETS FOR THE LAST TWO FISCAL YEARS.
2. INTERNALLY PREPARED FINANCIAL STATEMENTS. COMPLETE WITH INCOME STATEMENTS AND BALANCE SHEETS FOR THE
LAST TWO YEARS.

 BUSINESS INCOME TAX RETURNS FOR THE LAST TWO YEARS, INCLUDING K-1’S
 CURRENT INTERIM BUSINESS FINANCIAL STATEMENTS (if more than 90 days has elapsed since your fiscal year end)
 CURRENT PERSONAL FINANCIAL STATEMENTS FOR EACH PRINCIPAL/OWNER AS INDICATED ON APPLICATION
 PERSONAL INCOME TAX RETURNS FOR THE PAST TWO YEARS FOR EACH PRINCIPAL/OWNER AS INDICATED ON APPLICATION,
INCLUDING K-1’S

 COPIES OF ARTICLES OF INCORPORATION WITH BY-LAWS AND AMENDMENTS/GENERAL OR LIMITED PARTNERSHIP AGREEMENT/
LIMITED LIABILITY COMPANY ARTICLES OF ORGANIZATION AND AMENDMENTS AND OPERATING AGREEMENT

 COPY OF INVOICE OR PURCHASE CONTRACT TO PURCHASE FIXED ASSETS

 BORROWING RESOLUTION

COMMENTS OR ADDITIONAL INFORMATION

BANK USE ONLY

LOAN OFFICER: DATE RECEIVED:

 NEW  REFINANCE/CONSOLIDATION OF FIRST BANK DEBT  RENEWAL WITH NEW ADVANCE  OTHER MODIFICATION (Explain):
 APPROVED  DECLINED  WITHDRAWN BY APPLICANT(S)  APPLICATION APPROVED BUT NOT ACCEPTED BY APPLICANT(S)
COMMENTS:
 LOAN OFFICER:
IMPORTANT INFORMATION
Please help us to understand your business and how it works by completing the application and attaching the
information requested below. This application provides the bank with the information it needs to properly consider your
loan request to meet your needs. Please note that we cannot begin to evaluate your loan request until your lender
receives your completed, signed, and dated application in person or by mail to the address listed on the cover page.
112 WEST KING STREET, STRASBURG, VIRGINIA 22657 Please note additional information may be required in some circumstances.
DO NOT LEAVE ANY BLANKS, FILL IN WITH “N/A” IF NON-APPLICABLE.
LOAN REQUEST
AMOUNT REQUESTED: $ TERM: DATE:

 LINE OF CREDIT  INSTALLMENT (TERM) LOAN  MORTGAGE (CHOOSE ONE: OWNER OCCUPIED OR INVESTMENT PROPERTY)  LETTER OF CREDIT  OTHER:

PURPOSE OF LOAN:

HOW WILL THE LOAN PROCEEDS BE REPAID?

HAVE YOU EVER APPLIED FOR OR BEEN DENIED CREDIT BY FIRST BANK?  YES  NO
GENERAL INFORMATION
BUSINESS NAME: (EXACT LEGAL NAME OF BUSINESS; FOR INDIVIDUALS PLEASE USE YOUR FULL LEGAL NAME) TAX ID#:

D/B/A NAME: (IF ANY) YEAR ESTABLISHED: # OF EMPLOYEES:

BUSINESS ADDRESS: COUNTY:

WEB ADDRESS: EMAIL: BUSINESS PHONE:

FAX:

LEGAL RELATIONSHIP:  CORPORATION  PARTNERSHIP  SOLE-PROPRIETORSHIP  LLC  LLP  OTHER, please describe:
(CHECK ONE)
 FRANCHISE, in full force and without defaults, with (Name of Franchiser):
STATE OF ORIGINATION: COUNTY OF ORIGINATION:

ANY CHANGES TO THE CORPORATE STRUCTURE WITHIN THE PAST 12 MONTHS?  YES  NO (if yes, please provide details in “Business Operations” section)

NATURE OF BUSINESS:  RETAILER  DISTRIBUTOR  WHOLESALER  MANUFACTURER  PROFESSIONAL  SERVICE

(CHECK ONE)
 AGRICULTURE  OTHER, please describe:
BUSINESS FISCAL YEAR:  CALENDAR YEAR  OTHER, please describe:
PRINCIPALS/OWNERS (PLEASE PROVIDE A COMPLETED PERSONAL FINANCIAL STATEMENT FOR EACH NAME LISTED)
NAME TITLE/FUNCTION SOCIAL SECURITY # % OWNED

INSURANCE COVERAGE
Loans serviced by fixed assets will require those assets to be insured. Please list the name and company information of your insurance provider.
INSURANCE COVERAGE DOLLAR COVERAGE INSURANCE COMPANY AGENT NAME AGENT ADDRESS AGENT PHONE #

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MISCELLANEOUS (PLEASE PROVIDE FURTHER WRITTEN DETAILS IF YOU ANSWER YES TO ANY OF THE FOLLOWING QUESTIONS)
DOES THE BUSINESS OWE TAXES FOR YEARS OTHER THAN THE CURRENT YEAR?  YES  NO IF YES, PLEASE INDICATE AMOUNT: $

IS THE BUSINESS AN ENDORSER, GUARANTOR, OR COMAKER FOR OBLIGATIONS NOT LISTED ON ITS FINANCIAL STATEMENTS (INCLUDING LEASE OBLIGATIONS)?  YES  NO
IF YES, PLEASE INDICATE AMOUNT OF TOTAL LIABILITY: $

IS THE BUSINESS IN COMPLIANCE WITH ALL APPLICABLE FEDERAL, STATE AND/OR LOCAL REGULATIONS (I.E. ENVIRONMENTAL, SAFETY, EMPLOYMENT, ETC.)?  YES  NO
IF NO, PLEASE DESCRIBE:

HAS THE BUSINESS EVER BEEN CITED FOR A VIOLATION OF ANY OF THE ABOVE MENTIONED REGULATIONS?  YES  NO
IF YES, PLEASE DESCRIBE:

ARE THERE ANY DELINQUENT FICA, SALES TAX OR ERISA PAYMENTS?  YES  NO

IS THE BUSINESS OR ANY PRINCIPAL/OWNER A PARTY TO ANY CLAIM OR LAWSUIT? HAS THE BUSINESS OR A PRINCIPAL/OWNER EVER DECLARED BANKRUPTCY?
 YES  NO  YES  NO
OTHER FINANCIAL SERVICE NEEDS (CHECK ALL THAT APPLY)
 COMMERCIAL SERVICES:  MERCHANT CARD PROCESSING, 1ST DATA  ACH ORIGINATION  @firstbusiness ONLINE BANKING  REMOTE DEPOSIT CAPTURE
 WEALTH MANAGEMENT:  401(k)  LIFE INSURANCE  LONG-TERM CARE INSURANCE  STOCK /BONDS/MUTUAL FUNDS/ANNUITY/SELF-DIRECTED IRA  TRUST  ESTATE SETTLEMENT
 PERSONAL ACCOUNTS:  CHECKING  E-CHECKING  MONEY MARKET ACCOUNT  SAVINGS  STUDENT SAVINGS  CERTIFICATE OF DEPOSIT  CREDIT CARD
 RESIDENTIAL MORTGAGE:  PURCHASE NEW HOME  REFINANCE EXISTING HOME  HOME EQUITY LINE OF CREDIT

CREDIT DENIAL NOTICE: If your gross revenues were $1,000,000 or less in your previous fiscal year, or you are EQUAL CREDIT OPPORTUNITY NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from
requesting trade credit, a factoring agreement, or similar types of business credit in this Commercial Loan Application, discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age
and if your application for business credit is denied, you have the right to a written statement of the specific reasons for (providing the applicant has the capacity to enter into a binding contract), because all or a part of the applicant’s
the denial. To obtain the statement please contact (Name, address, and telephone number of the person or office from income derives from any public assistance program, or because the applicant has in good faith exercised any right
which the statement of reasons can be obtained): under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning
FIRST BANK, 112 WEST KING STREET, STRASBURG, VA 22657 (540)465-9121 this creditor is:
Within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the FEDERAL RESERVE CONSUMER HELP CENTER 1-888-851-1920
denial within 30 days of receiving your request for the statement. The notice that follows describes additional PO BOX 1200, MINNEAPOLIS, MN 55480
protections extended to you.

 NOTICE OF INTENT TO APPLY FOR JOINT CREDIT, By signing below, we acknowledge the intention to apply for joint credit on this date.

SIGNATURES. By signing below, Loan Applicant submits this application and the information provided on all accompanying financial statements and schedules for the purpose of
obtaining credit and represents that the information submitted is accurate and complete. Loan Applicant acknowledges that representations made in this application will be relied on
by Lender in evaluating this application and, if approved, in extending credit. Loan Applicant represents that none of the parties named in this application have relied on advice from
the Lender in applying for or receiving any credit. Loan applicant acknowledges that Lender has not made any commitment to approve this application and extend credit, unless
otherwise agreed to in writing. Lender is authorized to conduct any inquiries it decides are necessary to verify the accuracy of the information contained in this application and to use
any reasonable method to determine the creditworthiness of the Loan Applicant. Lender is also authorized to answer any questions from others about Lender’s credit experience with
the parties in this application. Loan Applicant will promptly notify Lender of any subsequent changes which would affect the accuracy of this application, and will provide all
documents and information that Lender decides are necessary to complete this application. Loan Applicant authorizes Lender to retain this application, whether or not Lender
approves any extension of credit. Any intentional misrepresentation of the information contained herein could result in criminal action under federal law.

In addition, each individual signing below authorizes the Creditor to check their individual credit account and employment history and have a credit reporting agency prepare a
consumer credit report on them.

By signing below, the undersigned agree(s) to all the terms and conditions beginning on page 1 through the bottom of page 2 of this Application

Applicant Name

By
for Applicant Title Date

By
for Applicant Title Date

By
for Applicant Title Date

By
for Applicant Title Date

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