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Business Loan Application
BORROWER INFORMATION
Legal Business Name
Tax ID#
D/B/A or Trade Name (if applicable)
Phone Number
( )
Primary Business Address (Physical Street Address – no P.O. Box please)
City
State
Zip Code
Business Mailing Address (if different - i.e. P.O. Box)
City
State
Zip Code
Email
Description of Business / Products or Services Offered
Date Business Established
Current Ownership Since (Date)
State of
Organization
LOAN REQUEST INFORMATION
Type of Loan
Amount
($10,000 - $250,000)
Overdraft Protection
Purpose of Loan
Line of Credit
$
Yes - Business Account #
__________________________
Term Loan
$
Commercial Mortgage
$
Letter of Credit
$
BUSINESS DEPOSIT ACCOUNTS (Please attach a separate sheet if more space is needed)
Financial Institution
Account Type
Current Balance
BUSINESS DEBT (Please attach a separate sheet if more space is needed)
Financial Institution
Type of Loan
Current Balance
Collateral
Being paid off
with this loan?
$
YES
NO
$
YES
NO
COLLATERAL INFORMATION (Describe collateral offered to secure this loan) If cash or marketable securities, list separately below and provide
statements or stock certificates. For General Business Assets, list all addresses where the assets are located.
Collateral Description or Property Address
Purchase Price / Value
Prior Liens /
Creditor
$
$
AUTHORIZATION AGREEMENT
The undersigned person(s) certifies that he/she has full authority to act on behalf of the business (the "Applicant") identified on the Business Loan Application
(the "Application), and that all information contained herein is true and correct in all respects. Webster Bank, N.A. (the "Bank") is hereby authorized to verify
any information provided in connection with the Application. The Bank may obtain credit reports for all owners / guarantors expected to be personally liable,
and may also do so for updates, renewals, extensions and any collection activity or as otherwise permitted by law. Under the federal Fair Credit Reporting
Act, the Bank may get or share information regarding the Applicant, guarantor(s) or Applicant's owner(s) with Bank affiliates unless the undersigned tells the
Bank not to share. The undersigned may prohibit the Bank from sharing information provided or obtained by the Bank from a third party, by mailing a written
request to Webster Bank, Business Banking, 609 West Johnson Avenue, Cheshire, CT 06410. The Application will be the Bank's property whether or not
credit is granted. Applicant agrees that the Bank may rely on a facsimile of the Application and any other signed documents received by the Bank by
facsimile transmission relating to the credit granted pursuant to the Application. Such facsimiles or any copy of such facsimiles shall be binding on Applicant
and shall for all purposes be considered original documents. The undersigned understands that making false statements or material omissions intended to
conceal pertinent facts may be a financial crime requiring referral to appropriate law enforcement officials. The undersigned further agree to notify the Bank
immediately of any change in name, address or employment, and any material change in (a) any of the information contained in the Application, or (b) the
financial condition of any of the undersigned, or (c) the ability of any of the undersigned to perform its or their obligations to the Bank. Applicant agrees that if
the Bank elects to include Applicant in the Bank's SBA (U.S. Small Business Administration) loan program, the Bank may submit an SBA loan application on
behalf of the Applicant using the information contained in the Application and other information obtained from the Applicant.
Applicant (Business) Legal Name (please print)
Officer / Member Signature
X
Title
Date