/ 4120 Douglas Blvd. #306-521
Granite Bay, CA 95746
www.dficapital.com
Email your loan application and submission documents to
Borrower Name / Date of Birth / Social Security No.
Home Address / Yrs. There
City / State
/ Zip Code / Home Phone
Own or Rent? / Cell Phone / Fax / Email
Employer / Work Phone
Employer Address / City / State
/ Zip Code
Position
/ Yrs. There
Co-Borrower Name / Date of Birth / Social Security No.
Home Address / Yrs. There
City / State
/ Zip Code / Home Phone
Own or Rent? / Cell Phone / Fax / Email
Employer / Work Phone
Employer Address / City / State / Zip Code
Position
/ Yrs. There

YOU MAY APPLY FOR CREDIT EXTENSION OR

FINANCIAL ACCOMMODATION SEPARATELY OR JOINTLY

Are you requesting this financial accommodation: / Separately Jointly with your spouse
Jointly with another person (Please submit separate financial statements attached together.)
Marital Status (answer only if this financial statement is provided in connection with a request for secured credit or if you live in a community property state, such as California): / Married Separated
Unmarried (unmarried includes single, divorced, widowed)

Reflect in this statement the financial condition of your spouse as well as your own financial condition if:

1. You are seeking this financial accommodation jointly with your spouse, or

2. You are relying on your spouse’s assets or income in requesting this financial accommodation, or

3. You live in a community property state like California.

BUSINESS LOAN APPLICATION 06/2011

·  List all amounts in dollars. Omit cents.
·  Please attach a separate sheet if you need more space to complete a detail schedule
ASSETS / AMOUNT / LIABILITIES / AMOUNT
Cash in banks (Detail) / $ / Notes Payable (Schedule 7) / $
$ / $
Accounts Receivable / $ / Accounts Payable / $
Notes Receivable (Schedule 1) / $ / Income Taxes Payable / $
Mortgages & Deeds of Trust Owned (Schedule 2) / $ / Other Taxes Payable / $
Securities Owned (Schedule 3) / $ / $
Cash Surrender Value of Life Insurance (Schedule 4) / $ / Loans on Life Insurance (Schedule 4) / $
Real Estate (Schedule 5) / $ / Mortgages or Liens on Real Estate (Schedule 6) / $
Automobiles / $ / Installment Contracts Payable / $
$ / Credit and Charge Cards (Schedule 7) / $
Personal Property / $ / $
IRA Account / $ / Other Liabilities (Detail) / $
Other Assets (Detail) / $
$ / TOTAL LIABILITIES / $
$ / NET WORTH / $
TOTAL ASSETS / $ / TOTAL LIABILITIES PLUS NET WORTH / $
DATE OF STATEMENT:
MONTHLY INCOME / MONTHLY EXPENDITURES /

CONTINGENT LIABILITIES

Employment Income: Borrower

/ $ / Residence Payment (PITI) / $ / As Endorser / $
Employment Income: CoBorrower / $ / Rental Mortgage(s) (PITI) / $ / As Guarantor / $

Dividends

/ $ / Auto / $ / On Damage Claims / $

Interest

/ $ / Utilities / $ / For Taxes / $

Rentals (Schedule 5)

/ $ / Revolving Credit / $ / Other (Detail) / $

Alimony, child support or separate maintenance*

/ $ / Living Expense / $ / $
Income Taxes / $
/ Alimony, child support/maint. / $ / $
/ Other / $ / $

Other

/ $
$ / Check here if “None”

TOTALINCOME

/ $ / TOTAL
EXPENDITURES / $ / TOTAL
CONTINGENT
LIABILITIES / $

*Only show if you wish us to consider in your application.

SCHEDULE 1 NOTES RECEIVABLE

NAME OF DEBTOR / COLLATERAL / PAYABLE / MATURITY DATE / TOTAL
AMOUNT DUE
$ per / $
$ per / $
$ per / $

TOTAL

/ $

SCHEDULE 2 MORTGAGES AND DEEDS OF TRUST OWNED

NAME OF DEBTOR / LIEN
POSITION / PROPERTY
VALUE / PRIOR LIENS / HOW PAYABLE / MATURITY
DATE / UNPAID BALANCE
$ / $ / $ per / $
$ / $ / $ per / $
$ / $ / $ per / $

SCHEDULE 3 SECURITIES OWNED

NO. SHARES
OR BOND AMOUNT / EXCHANGE
N - NYSE
A - AMEX
0 - OTC
L- UNLISTED / DESCRIPTION / TITLE IN NAME OF / HOW
HELD CODE* / PRICE PER SHARE / TOTAL MAKET
VALUE / PLEDGED?
Y - YES
N - NO
$ / $
$ / $
$ / $

TOTAL

/ $

SCHEDULE 4 LIFE INSURANCE

INSURED / FACE AMOUNT
OF POLICY / INSURANCE COMPANY / BENEFICIARY / CASH VALUE / LOANS
$ / $ / $
$ / $ / $
$ / $ / $
TOTAL
/ $ / $

SCHEDULE 5 REAL ESTATE

ADDRESS AND TYPE OF PROPERTY
(Type: SD=single dwelling, MF=multi-family, C/I=commercial/industrial) / TITLE IN NAME OF / HOW
HELD
CODE* /
COST
YEAR ACQUIRED / MONTHLY
INCOME /
PRESENT MARKET
VALUE / TOTAL BALANCE
OWED (DETAIL IN SCHEDULE 6)
1. / $ / $ / $ / $
Year
2. / $ / $ / $ / $
Year
3. / $ / $ / $ / $
Year
4. / $ / $ / $ / $
Year
TOTAL / $ / $ / $ / $

SCHEDULE 6 MORTGAGES OR LIENS ON REAL ESTATE

PROP-ERTY
NO. / TO WHOM PAYABLE / INDICATE 1ST OR 2ND MORTGAGE / HOW PAYABLE / INTEREST RATE / MATURITY DATE / BALANCE OWING
$ per / % / $
$ per / % / $
$ per / % / $
$ per / % / $

SCHEDULE 7 NOTES PAYABLE AND REVOLVING CREDIT

NOTES PAYABLE- TO WHOM /
ADDRESS
/ COLLATERAL / INTEREST RATE / UNPAID BALANCE
% / $
% / $
REVOLVING CREDIT
CREDITOR’S NAME / ACCOUNT # / BALANCE OWING / MONTHLY PAYMENT / MATURITY DATE / TOTAL COMMITMENT
$ / $ / $
$ / $ / $
$ / $ / $
TOTALS / $ / $ / $
*HOW HELD CODES / COMMUNITY PROPERTY /

SEPARATE PROPERTY (INDICATE APPLICABLE ABBREVIATION)

ALWAYS INDICATE “CP” /

“SO” = SINGLE OWNERSHIP

/

“JT” = JOINT TENANTS

/

“TIC” = TENANTS IN COMMON

ENTITY INFORMATION

Business Name / Tax ID # / Type of Business / Date Established / Ownership %

DECLARATIONS

Have you ever gone through bankruptcy or compromised a debt? Yes No

If yes, please give details.

Have you ever been a principal or guarantor of a firm or entity that

declared bankruptcy or compromised a debt?If yes, please give details. Yes No

Are there any suits, judgments, executions or attachments pending

against you? If yes, please give details. Yes No

Are any assets held under a trust agreement? If yes, please give details. Yes No

Are any assets pledged or debts secured except as shown? Yes No

If yes, please give details.

Have you ever been charged with any criminal offense, Yes No

misdemeanor or felony?

Have you made a will? Yes No

YOUR REPRESENTATIONS AND WARRANTIES

I understand that DFI Capital Inc., and it’s affiliates are relying on the information in this business credit application in deciding to give or continue the extension of credit I have requested or received. I promise that this is a true statement of my financial condition as of the date indicated. You may rely on it as being true and complete until I otherwise notify you in writing. If this statement is not true in any material respect, or if I should die, file for bankruptcy, if any other creditor tries to seize my property, or if any adverse change occurs in my financial condition, at your election any or all of my indebtedness and obligations to you, direct or contingent, shall become immediately due and payable without demand or notice. You may retain and verify this statement. I understand that from time to time you may receive information about me from others and may answer questions and requests from others seeking credit and experience information about me and my relationship with you. If this is a joint financial statement, these representations and warranties are from each of us. I/we authorize the Bank to make whatever credit inquiries it deems necessary in connection with this financial statement. I/we authorize and instruct any person or consumer reporting agency to furnish to DFI Capital, Inc. any information that it may have or obtain in response to such credit inquiries.

I/we also hereby certify that no payment requirements listed herein are delinquent or in default except as follows; if “NONE” so state. ______. ______

Borrower Initial Co-Borrower Initial

I/we fully understand that it is a federal crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts, pursuant to 18 U.S.C. Section 1014.

I HAVE READ, UNDERSTAND AND AGREE TO MAKE THESE REPRESENTATIONS AND WARRANTIES.

X ______X ______

Borrower Date Co-Borrower Date

I understand that if the loan is made in the name of an entity, I will be required to personally guaranty the debt.

X ______X ______

Borrower Date Co-Borrower Date

BUSINESS LOAN APPLICATION 06/2011