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On-Line Application

GENERAL INFORMATION FORM
Operating Company Name
 
Trade Name
 
Address
 
County
 
City
 
State
 
Zip
 
Business Telephone  
 
Facsimile
 
Mobile Phone
 
Operating Company Tax ID Number
 
Entity Type
 
Operating Company Start Date
 
Existing or New business
 Existing
 New
 
 
Is business engaged in exporting?
 Yes
 No
 
 
Is your company involved in any bankruptcy/insolvency proceedings?
 Yes
 No
 
 
Have any company officers been involved in bankruptcy/insolvency proceedings?
 Yes
 No
 


 
The next six answers are not required. However, the SBA may offer additional benefits for businesses owned 51 percent or more by women, minorities, veterans, or for businesses accomplishing specific public policy goals.
Veteran Owned?
 Yes
 No
 
Woman Owned?
 Yes
 No
 
Minority Owned?
 Yes
 No
 
Is project located in a community revitalization or redevelopment area?
 Yes
 No
 Unsure
 
Is the project located in an area affected by federal budget cutbacks?
 Yes
 No
 Unsure
 
Will the proceeds be used for plant re-tooling or modernization of manufacturing facilities?
 Yes
 No
 



 



 
COMPANY PRINCIPALS
A Principal Information Form should be completed for each individual listed below with 20 percent or greater ownership. A Principal Information Form can be found later in this On-Line Application.
Stockholders/Owners Title Ownership %
(must total 100%)
%
%
%
%
%

 
OTHER KEY CORPORATE OFFICERS
Name Title

 
INFORMATION ON PROPERTY TO BE ACQUIRED
Seller name
Address
City
State
Zip
County
Phone Number
Email
Percentage of building to be occupied by the operating business (Please estimate if unsure).
 %

 
ELIGIBLE PASSIVE COMPANY (EPC) INFORMATION
An eligible passive company is defined as a company created to hold ownership of property or real estate associated with the project.
Are you planning on forming an EPC (If no, go to next section) ?
 Yes
 No
 Unsure - please fill in the blanks with "To Be Determined" or "TBD."
EPC Name
EPC Start Date

 
EPC Ownership Percentage
Name Title Ownership %
%
%
%
%
%

 
JOB CREATION
Please estimate if unsure.
Number of current employees?
Jobs to be created in the next two years?
Number of jobs to be retained due to the project?


 
TOTAL LOAN AMOUNT REQUESTED
(not including soft and/or closing costs). Please estimate if unsure.
Real Estate (Purchase Price)
Construction/Renovations
Equipment
Total

 
DESCRIPTION OF PROJECT
Please describe what the proceeds of the loan will be used for.

 
NARRATIVE HISTORY OF BUSINESS
Please describe the history of the business, competitive advantages, key customers and major competitors.

 
As part of this application, I/We understand that Capital Finance and its authorized agents may make inquiries they deem necessary in evaluating the loan request for the Applicant and Guarantors listed below. The Applicant and Guarantors authorize Capital Finance to undertake the following:

1. Verify, at any time, any information submitted to Capital Finance by the Applicant, Guarantors, or their representatives or agents on their behalf.

2. Obtain Further information concerning the credit standing of the Applicant and Guarantors.

3. Exchange such credit information with other interested parties as Capital Finance deems necessary for this loan request only. This authorization includes permission to obtain Business and Consumer Credit Reports on the Applicant and Guarantors as deemed necessary by Capital Finance.  For the purposes of this online application, typing your name(s) below constitutes the equivalent of your signature until such time as a Capital Finance representative can secure your authorized signature for this loan submission.
APPLICANT NAME
BY: , as
Title
GUARANTOR NAME
BY: , as Guarantor
GUARANTOR NAME
BY: , as Guarantor



 



 
PRINCIPAL INFORMATION FORMS
Please list information on all company principals, owners or loan guarantors.  Anyone who co-signs for the loan or owns more than 20 percent of stock in the operating company should be listed as a principal.  If you have more than one principal in your company,  print out additional forms to submit via email or fax.
Principal 1  
First name
Middle name
Last name
Aliases or Maiden Names (If known by more than one name, please give dates)
Name 1 From to (mo/yr)
Name 2 From to (mo/yr)
Title
Ownership Percentage
 %
Date of Birth
Place of Birth
Social Security Number
US Citizen? (if no, please provide resident alien number and send in a copy of the front and the back of your resident alien card)
 Yes
 No, my Resident Alien Number is
Home Telephone
Home Address From to (mo/yr)
City
State
Zip
Prior Home Address
(if fewer than 10 years at above)		 From to (mo/yr)
City
State
Zip
Have you ever been an active member of the U.S. military?
 Yes
 No
 
If yes, were you honorably discharged?
 Yes
 No
 

 
DISCLOSURES
It is important that the next three questions be answered completely.  An arrest or conviction record will not necessarily disqualify you; however, an untruthful answer will cause your application to be denied.  If you answer "yes" to any of the following three questions, furnish details on a separate submission with any documentation (include dates, location, fines, sentences [whether misdemeanor or felony], dates of parole/probation, unpaid fines or penalties, name(s) under which charged, and any other pertinent information).
Are you presently under indictment, on parole or probation? (If yes, indicate date parole or probation is to expire)
 Yes
 No
Have you ever been charged with and/or arrested for any criminal offense other than a minor motor vehicle violation?  Include offenses that have been dismissed, discharged, or not prosecuted.  (All arrests must be disclosed and explained in a separate submission).
 Yes
 No
 
Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation, for any criminal offense other than a minor vehicle violation?
 Yes
 No
 
MANAGEMENT RESUME
Please fill in all spaces. If an item is not applicable, please indicate such. If you would like to submit a different version of your resume, please do so. If you have more than one principal in your company, click here to print out additional forms to submit via email or fax.

Personal information:
Name
SSN
Date of Birth
Place of Birth
Home Phone
Work Phone
Home Address From to (mo/yr)
Previous Home Address From to (mo/yr)
Spouse Name
Spouse SSN
Are you employed by the U.S. Government? (If yes, Agency/Position)
 Yes
 No
Are you a U.S. citizen? (If no, give Alien Registration Number)
 Yes
 No
 
Education:    
High School, College, Technical School Name & Location Dates Attended Major Degree/Certificate
 
Military Service Background:
Branch of Service
Date of Service
 
Work Experience: (List chronologically, starting with present employment.)
Company Name/Location From To Duties
 
AGING SUMMARY OF ACCOUNTS RECEIVABLE (A/R) AND ACCOUNTS PAYABLE (A/P)
(A/R and A/P must match interim balance sheet and be dated the same ).
If you have your own version of an aging summary, please feel free to submit it via email or fax in lieu of this portion of the online application. If you do not age your receivables or payables, please state so on your company letterhead and submit it via email or fax in lieu of this portion of the online application.
Accounts Receivable (Under 30 Days)
Accounts Receivable (30 - 59)
Accounts Receivable (60 - 89)
Accounts Receivable (90+)
Accounts Payable (Under 30 Days)
Accounts Payable (30 - 59)
Accounts Payable (60 - 89)
Accounts Payable (90+)
List any customer concentrations that are greater than or equal to 10% of total A/R:
Name % Any Issues
%
%
%
%
%
List any customers with A/R over 90 days and indicate whether account is collectable:
Name Collectable (Yes/No) Extended Terms
List any A/P over 90 days and indicate whether you have extended terms and list terms:
Name Extended Terms (Y/N) Extended Terms
BUSINESS SCHEDULE OF LIABILITIES
These are your existing Debt Obligations.  List separately all obligations of the company evidenced by note or capital lease.  This section requires more detail than that found on any CPA prepared financial statements.  It is a critical part of the information we analyze. If you have your own version of your company's liabilities, please feel free to submit it via email or fax in lieu of this portion of the online application.  If your company currently has no liabilities to list, please state so on your company letterhead and submit it via email or fax in lieu of this portion of the online application.
Name of Creditor Original Amount Date Present Balance Interest Rate Monthly payment Other payment Maturity date Collateral
The information contained on this schedule is a supplement to your balance sheet and should balance to the liabilities presented on that form.
PERSONAL FINANCIAL STATEMENT
Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan.  If you have more than one principal in your company, print out additional forms to submit via email or fax.
Name
Work Phone
Home Phone
City
State
Zip
Applicant/Borrower
 
ASSETS  
Cash on hand & in Banks
Savings Accounts
IRA or Other Retirement Account
Accounts & Notes Receivable
Life Insurance-Cash Surrender Value Only
Stocks and Bonds
Real Estate
Automobile-Present Value
Other Personal Property
Other Assets
TOTAL:
   
 
LIABILITIES  
Account Payable
Notes Payable to Banks and Others
Installment Account (Auto) Mo. Payments
Installment Account (Other) Mo. Payments
Loan on Life Insurance
Mortgages on Real Estate
Unpaid Taxes
Other Liabilities
Total Liabilities
Net Worth (Assets minus Liabilities)
 
Section 1.

Source of Income		  
Salary
Net Investment Income
Real Estate Income
Other Income: Describe:


 
 
Contingent Liabilities  
As Endorser or Co-Maker
Legal Claims & Judgments
Provision for Federal Income Tax
Other Special Debt
* Alimony or Child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted towards total income.
 
Section 2.

Notes Payable to Banks and Others.
Name and Address of Noteholder(s)
Original Balance
Current Balance
Payment Amount
Frequency (monthly, etc.)
How secured or Endorsed Type of Collateral
 
Section 3.

Stocks and Bonds.
Number of Shares
Name of Securities
Cost
Market Value Quotation or Exchange
Date of Quotation or Exchange
Total Value
 
Section 4.

Real Estate Owned. (List each parcel separately.)
Real Estate A
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name & Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment per Month/Year
Status of Mortgage
 
Real Estate B
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name & Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment per Month/Year
Status of Mortgage
 
Real Estate C
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name & Address of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment per Month/Year
Status of Mortgage
 
Section 5.
Other Personal Property and Other Assets.  (Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and if delinquent, describe delinquency).
Section 6.
Unpaid Taxes. (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches).
Section 7.
Other Liabilities. (Describe in detail).
Section 8.
Life Insurance Held. (Give face amount and cash surrender value of policies ­ name of insurance company and beneficiaries).

I authorize Capital Finance and/or assigns to make inquires as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify that the above, and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan.
Name: Date: SSN:
Name: Date: SSN:

For the purposes of this online application, typing your name(s) constitutes the equivalent of your signature until such time as an Capital Finance representative can secure your authorized signature for this loan submission.
 

 

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Contact Information:

Telephone:
(760) 776-5749
Facsimile:
(760) 776-9179
Postal address:
Capital Finance
45605 Navajo Drive
Indian Wells, California 92210-8872
Electronic mail
General Information:     CapitalFin@pipeline.com
Loan Information:         Loan Information@IndianWellsCapital.com
Underwriting:                Underwriting@IndianWellsCapital.com

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Last modified: June 06, 2010
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