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Credit Request
DWJ Rep:  
     Line of Credit   $       /
     Term Loan   $       /
   Collateral Description (Acct # if CD/Brokerage):  
   Owner(s) of Collateral:    Prior Liens   yes   no
   Collateral Address:    City:  
   County:  State: Zip:   Purchase Price (If New) $   Market Value (If Refi) $

 

COMPANY INFORMATION (An extra copy is necessary for each company guarantor)
   
  Primary Borrower   Borrower   Guarantor
   C-Corp    Sub-S Corp    LLC    General Partnership    Sole Proprietorship    Other
   Legally Registered Company Name:   Trade or DBA Name:
   Federal Tax ID:  
   Physical Address (No PO Box):    City:   State: Zip:
   Physical Address (No PO Box):    City:   State: Zip:
   Nature of Business:     State: Date Established:
   Primary Contact:    Business Phone:    Primary Bank: Other
   Gross Annual Sales $    12-Month Avg. Business Checking Balance $   

 


OWNER / GUARANTOR INFORMATION (Required for each individual with 20% or more ownership of company)

Primary Borrower Borrower Guarantor
Hypothecator
  Name:  
  Social Security Number:
  Ownership %   Owner Since
  Home Address:
  City:   State:    Zip:
  Home Phone:   Date of Birth: 
  Primary Bank:  
  Monthly Mortgage/Rent (Personal residence) $  
 
  Total Liquid Accts $  Retirement Accts $
  12 Month Avg. Checking Balance $
  Adj. Annual Gross Income $
  (From Tax Return)		  Net Worth $
 (Excluding Business Value)

Borrower Guarantor Hypothecator

  Name:  
  Social Security Number:  
  Ownership %   Owner Since
  Home Address:
  City:   State:    Zip:
  Home Phone:   Date of Birth:
  Primary Bank:  
  Monthly Mortgage/Rent (Personal residence) $ 
 
  Total Liquid Accts $  Retirement Accts $
  12 Month Avg. Checking Balance $
  Adj. Annual Gross Income $
  (From Tax Return)		  Net Worth $
 (Excluding Business Value)

 

Declaration
  
* I accept the terms and conditions for this application

 
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