Please, fax this Form to 1-650-697-7754

 

 

 

   Request for Financing:                    

Date of Request:

 

Loan Type:

 

TOTAL Amt ($) Requested:

 

Estimated Equip $:

 

Estimated Working Cap. $:

 

Description of Financing Needs: 

The above estimates represent the entire office financing needs, and

Sky Financial Solutions will be the only financing source for the project.

 

Business Information:

Name:

 

Type of Practice:

 

Tax ID #:

 

Business Address:

 

Organization Type:

 

 

 

State of Organization:

 

Phone Number:

 

Date of Organization:

 

Fax Number:

 

 

Applicant Information:                                                                   Co-Applicant Information (If applicable):

Full Name:

 

 

Full Name:

 

Social Security #:

 

 

Social Security #:

 

Date of Birth:

 

 

Date of Birth:

 

Home Address:

 

 

Home Address:

 

 

 

 

 

,

Phone Number:

 

 

Phone Number:

 

Business Status:

 

 

Prof. License #:

 

Prof. License #:

 

License Date:

 

 

License Date:

 

Are you a US Citizen?

 

 

Are you a US Citizen?:

 

     If No, INS Status?:

 

 

     If No, INS Status?:

 

Ever File Bankruptcy?

 

 

Ever File Bankruptcy?

 

     If Yes, When?:

 

 

     If Yes, When?:

 

Application Consent & Disclosure

On submission of signed application, you (1) represent you are a sole proprietor or authorized officer, member, agent or partner of a business applying for all available financial services and products of Sky Financial Solutions, Inc/Sky Bank (“Sky”); (2) agree you individually and your business will be bound under terms of your agreement(s) with Sky; (3) agree to any changes to those agreement(s); (4) agree any credit extended will only be used for business purposes; (5) warrant all information in this application is true, complete and correct; (6) authorize Sky to obtain, verify and exchange with its affiliates and non-Sky companies, credit reports and information contained in them and this application to review this application, and for periodic reviews, updates, renewals, extensions and collection.  You will be given the name and address of any credit bureau providing a report on request.  Subject to credit approval.  Some restrictions may apply, including limits on the amount of personal and consumer debt that may be consolidated. NOTICES: ECOA: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives 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 Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580.  CA Residents: If approved, you may receive a loan up to the approved amount.  You may be liable for credit extended under your loan, if approved, to any join applicant. California law requires us to inform you that should you fail to fulfill the terms of your credit obligations, a negative report reflecting on your credit record may be submitted to a credit reporting agency.  OH Residents:  The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers and that credit reporting agencies maintain separate credit histories on each individual upon request.  The Ohio Civil Rights Commission administers compliance with this law.  VT: A consumer credit report may be requested in connection with this application or in connection with updates, renewals, or extensions of any credit granted as a result of this application.  Upon your request, you will be informed whether or not such report was requested and, if so, the name and address of the agency that furnished the report.  Married WI Residents: No provision of any martial property agreement, unilateral statement, or court order applying to marital property will adversely affect a creditor’s interests unless prior to the time credit is granted, the creditor is furnished with a copy of the agreement, or statement or court order, or has actual knowledge of the provision.  FL Residents: You (borrower) agree that, should we obtain a judgment against you, a portion of your disposable earnings may be attached or garnished (paid to us by your employer), as provided by Florida and Federal Law. DISCLOSURES REQUIRED BY USA PATRIOT ACT OF 2001 IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.  What this mean to you:  When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you.  We may also ask to see your driver’s license or other identifying information.

Signature of Applicant:

 

 

 

Signature of Co-Applicant:

 

 

Signature                                                                     Date

Signature                                                                    Date



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