FORGE Loan Application

FORGE Loan Application

P.O. Box 1138, Huntsville, AR 72740

479-738-1585 Phone

479-738-6288 Fax

Please take your time filling out this application. If you need help, please contact FORGE and a staff member will be available to help you.

All applicants must fill out pages 2 through 5. Small business applicants requesting $20,000 or more must fill out pages 6 and 7 and/or send in a business plan.

PAGE 1 COVER

PAGE 2 CONTACT INFORMATION

PAGE 3 COLLATERAL

PAGE 4 PERSONAL FINANCIAL STATEMENT

PAGE 5 PERSONAL FINANCIAL STATEMENT (detail)

PAGE 6 DESCRIPTION OF BUSINESS

PAGE 7 PRO FORMA BALANCE SHEET

ECOA Notice: The Federal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (providing the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income is derived from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that administers compliance with this law concerning this creditor is the U.S. Small Business Administration, Washington, DC 20416.

Qualified individuals with disabilities are entitled to receive accommodations to enable them to fully benefit from our programs and services. To make arrangements, contact a FORGE staff member by calling 479-738-1585 or email . The FORGE office is located at 204 Main Street in Huntsville, Arkansas. The FORGE office is handicap accessible.

CONTACT INFORMATION:

Applicant’s Name: DOB: / /

SS#: County of Residence:

Address:

City: State: Zip Code:

Home Phone: Cell Phone:

Place of Employment: Work Phone:

Address of Employment: Income: Position:

Email Address: How did you hear about FORGE?

Citizen Yes No U.S. Resident Yes No Veteran: Yes No

Race: American Indian or Alaskan Native Asian Black or African American

Native Hawaiian or Pacific Islander White Hispanic Non-Hispanic

If the farm or business is an existing business list income for previous year: $

(Please include form 1040, Schedule F and/or Schedule C)

Co-Applicant’s Name: DOB: / /

SS#: County of Residence:

Address:

City: State: Zip Code:

Home Phone: Cell Phone:

Place of Employment: Work Phone:

Address of Employment: Income: Position:

Email Address: How did you hear about FORGE?

Citizen: Yes No U.S. Resident Yes No Veteran: Yes No

Race: American Indian or Alaskan Native Asian Black of African American

Native Hawaiian or Pacific Islander White Hispanic Non-Hispanic

Name of nearest relative not living with you:

Address:

Home Phone: Work Phone:

Credit References:

Name: Phone #:

Name: Phone #:

COLLATERAL:

ALL FORGE LOANS ARE SECURED BY SOME FORM OF COLLATERAL. Acceptable collateral includes, but is not limited to, liens on tools, equipment, inventory, livestock, mortgages on real property, securities and qualified cosigners.

Applicants Name: Loan Amount:

I pledge the following items as security against this FORGE loan:

ITEM MODEL#/DESCRIPTION VALUE

REAL PROPERTY: (IF USED AS COLLATERAL)

Address:

( attach a legal description)

Value: $ Equity: $ Payment: $

Mortgage Holder (if any): Mortgage Balance $

OTHER:

Explain:

PERSONAL FINANCIAL STATEMENT:

NOTE: The personal financial statement is a legal document, deliberately misrepresenting your financial position in order to obtain a loan is bank fraud.

ASSETS (what you own): VALUE

Cash:

Savings: Include CD’s, IRA’s, Etc.

Accounts Receivable: What is owed to you by companies or individuals

Stocks and Bonds: Current Value

Real Estate: HOME (see page 5)

Real Estate: FARM (see page 5)

Real Estate: OTHER (see page 5)

Vehicle: Describe:

Vehicle: Describe:

Tools: Describe:

Equipment: Describe:

Personal Property: Describe:

TOTAL ASSETS:

LIABILITIES (what you owe):

Accounts Payable: Short term current debts: utilities, rent, tuition, etc.

Student Loans: Monthly Payments, Total $

Vehicle Debt: Monthly Payments, Total $

Mortgages: Monthly Payments, Total $

Credit Cards: Monthly Payments, Total $

Unpaid Taxes: Monthly Payments, Total $

Other Debts: Bank Loans, Installment Loans, Family, Friends, etc.

TOTAL LIABILITIES:

NET WORTH (Total Assets-Total Liabilities) $ Initial

PERSONAL FINANCIAL APPLICATIONS:

Applicant’s Name:

Do you have life insurance? Yes No Term or whole life? Amount $

Do you have medical / health insurance? Yes No Company

DESCRIPTION OF REAL PROPERTY:

Home: Appraised Value$ Mortgage Holder Balance $

Address:

Farm: Appraised Value $ Mortgage Holder Balance $

Address:

Other: Appraised Value $ Mortgage Holder Balance $

Address:

Unpaid Taxes, Judgements, Tax liens, etc. Explain:

Income: Salary $ Real Estate Income: $ Farm Income: $

Business Income: $ Other Income: $ Co-Signer Income: $

Total Family Income: $

I authorize FORGE, Inc. to make inquiries as necessary to verify the accuracy of the statements made to determine my credit worthiness. I certify the above 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. I understand that FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S. C. 1001).

Signature of Applicant: Date:

Signature of Co-Applicant: Date:

Witness (Name): Date:

Date: Address:

BUSINESS PLAN TEMPLATE

HOW MANY YEARS HAVE YOU BEEN IN BUSINESS?

VISION/MISSION STATEMENT AND GOALS: Describe what the business produces, who the products are for and what your goals are

KEYS TO SUCCESS: What do you need or what must happen for you to succeed?

RESOURCES, FACILITIES AND EQUIPMENT: List the land, equipment, human and financial resources

LIST THE MANAGEMENT TEAM? What is their experience running this type of business?

DO YOU HAVE A MARKETING PLAN? Explain:

WHAT DID YOUR BUSINESS GROSS LAST YEAR?

WHAT DID YOUR BUSINESS NET LAST YEAR?

BUSINESS PLAN TEMPLATE

PROFORMA BALANCE SHEET

PROJECTIONS EXPENSE: YEAR 1 YEAR 2

Costs of Goods Sold

Salaries

Payroll

Outside Sources

Supplies

Repairs and Maintenance

Advertising

Vehicle Expenses

Accounting, Legal

Rent

Phone, FAX, Internet

Utilities

Taxes

Depreciation

Other

Annual Loan Payments

TOTAL EXPENSES

GROSS PROFIT

NET PROFIT

(Gross Profit – Expenses)

WHAT ARE YOUR ANNUAL HOUSEHOLD EXPENSES? WHAT DOES IT COST YOU TO LIVE?

DO YOU HAVE ANY OTHER SOURCES OF INCOME? IF YES, EXPLAIN:

HOW MANY JOBS WILL YOUR BUSINESS CREATE? FULL TIME PART TIME

HOW MANY JOBS WILL YOUR BUSINESS RETAIN? FULL TIME PART TIME

OWNER NAME:

ADDRESS:

PHONE #:

BUSINESS EMAIL:

BUSINESS WEBSITE:

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