Application - Franchise Lending Group

- Step 1 of 18

Business Information

Company Name *

DBA *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date Business Started *

Business Type

Email Address *

Contact Phone *

How many stores do you own? *

STORE LOCATION INFORMATION

Is store address the same as above?

Store Address

Address Line 1

Address Line 2

City

State

Zip Code

Store Number

Type of Location

Store Landlord Name *

First

Last

Landlord Phone

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PRINCIPAL(S) INFORMATION

Principal Name & Title: *

First

Last

% ownership:

Social Security #

Net Value Year

Home address:

Address Line 1

Address Line 2

City

State

Zip Code

Is there a 2nd Principal?

Principal Name & Title: *

First

Last

% ownership:

Social Security #

Home address:

Address Line 1

Address Line 2

City

State

Zip Code

Is there a 3rd Principal?

Principal Name & Title: *

First

Last

% ownership:

Social Security #

Home address:

Address Line 1

Address Line 2

City

State

Zip Code

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TRANSACTION INFORMATION

Loan Purpose

Equipment List Total $:

Construction Total $:

Total Amount Requested $:

Term Requested (Months):

Estimated Closing Date:

Additional Information

Business Tax ID

Other

Additional Documentation Needed

2 Years Corporate Tax Returns

Click or drag a file to this area to upload.

2 Years Personal Tax Returns

Click or drag a file to this area to upload.

Current Profit & Loss Statement

Click or drag a file to this area to upload.

Personal Financing Statement

Click or drag a file to this area to upload.

Debt Schedule

Click or drag a file to this area to upload.

Store Roster Sheet

Click or drag a file to this area to upload.

SIGNATURES

I hereby certify that the information contained in this file is true and accurate to the best of my knowledge, and I hereby authorize JGFCS, credit reporting agencies, and other institutions the right to release credit information to their designee. A facsimile of this document with signature shall be considered an original.

Franchise Signature *

Clear Signature

Printed Name *

Date: *

Franchise Signature

Clear Signature

Printed Name:

Date:

Franchise Signature

Clear Signature

Printed Name:

Date:

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PERSONAL FINANCIAL STATEMENT

Applicant Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Since:

Owned / Rented?

Owned / Rented? $

Social Security #

Date Of Birth

Phone (Residence)

Phone (Work)

Employer

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Position Title:

Since:

Number Of Dependent Including Self

Marital Status

Do NOT provide this information if your application is for individual, unsecured credit

Do You Have A Co-Applicant?

Co-applicant Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Since:

Owned or Rented?

Owned / Rented $

Social Security #

Date Of Birth

Phone (Residence)

Phone (Work)

Employer

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Position Title:

Since:

Number Of Dependent Including Self

Marital Status

Do NOT provide this information if your application is for individual, unsecured credit

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Assets

Please complete all schedules and bring totals to the following section:

Cash (Schedule 1)

Securities-Publicly Traded (Schedule 2)

Securities-Closely Held (Schedule 3)

Life Insurance Cash Value (Schedule 4)

Receivables, Mortgages and/or Contracts I own (Schedule 5)

Personal Residences (Schedule 6)

Other Real Estate (Schedule 7)

Retirement Accounts (Schedule 8)

Automobile (List by age and type)

Do you have another automobile?

Automobile (List by age and type)

Do you have another automobile?

Automobile (List by age and type)

Personal Property

Other Assets (Describe)

Total Assets:

LIABILITIES

Please contact your Banker if you need assistance with completing these schedules. Round all amounts to the nearest $100

Short Term Notes Due Financial Institutions and others (Schedule 9)

Credit Accounts and Bills Due (Schedule 10)

Insurance Loans (Schedule 4)

Installment Loans and Contracts (Schedule 8)

Mortgages on Personal Residences (Schedule 6)

Mortgages on Other Real Estate (Schedule 7)

Taxes Due

Other Liabilities (Describe)

Total Liabilites:

Net Worth $ (Subtract Total Liabilities From Total Assets)

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Applicants Annual Income

Annual Salary

Bonuses/Commission

Dividends/Interest

Net Real Estate Income

*Income from alimony, child support, or maintenance payments need not be entered unless you want it considered as a basis for repayment.

Other (List)

Total Amount:

Co-Applicants Annual Income

Annual Salary

Bonuses/Commission

Dividends/Interest

Net Real Estate Income

*Income from alimony, child support, or maintenance payments need not be entered unless you want it considered as a basis for repayment.

Other (List)

Total Amount:

Please Answer Each Question:

Applicant (Y/N)

Co-Applicant (Y/N)

Are you a Co-Maker, Endorser, or Guarantor of any individual, corporation or partnership? *

Are you a Co-Maker, Endorser, or Guarantor of any individual, corporation or partnership?

If yes, describe:

Are you a defendant in a suit or legal action? *

Are you a defendant in a suit or legal action?

Have you ever gone through bankruptcy or had a judgement against you? *

Have you ever gone through bankruptcy or had a judgement against you?

Do you have any contested tax liens? *

Do you have any contested tax liens?

Have you made a will? *

Have you made a will?

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SCHEDULE 1 / CASH, SAVINGS, CERTIFICATES, AND MONEY MARKET ACCOUNTS

Note: Please ensure all sections are completed accurately with the requested banking and account details. Providing complete and precise information will help expedite the application review process. Let us know if you need any assistance.

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Do you have another Bank, Financial Institute of Brokerage Firm?

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Do you have another Bank, Financial Institute of Brokerage Firm?

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Do you have another Bank, Financial Institute of Brokerage Firm?

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Do you have another Bank, Financial Institute of Brokerage Firm?

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Do you have another Bank, Financial Institute of Brokerage Firm?

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Do you have another Bank, Financial Institute of Brokerage Firm?

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Do you have another Bank, Financial Institute of Brokerage Firm?

Name of Bank, Financial Institution or Brokerage Firm(s)

Type of Account

Name(s) on Account

Pledged?

Account Balance ($)

Total Amount:

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SCHEDULE 2 / SECURITIES OWNED - PUBLICLY TRADED/NON-RETIREMENT

Par Value or No. of Shares

Registered in Name(s) of *

Current Market Value ($)

Market Price per share

Description

Do you need to add another one?

Par Value or No. of Shares

Registered in Name(s) of *

Current Market Value ($)

Market Price per share

Description

Do you need to add another one?

Par Value or No. of Shares

Registered in Name(s) of *

Current Market Value ($)

Market Price per share

Description

Do you need to add another one?

Par Value or No. of Shares

Registered in Name(s) of *

Current Market Value ($)

Market Price per share

Description

Do you need to add another one?

Par Value or No. of Shares

Registered in Name(s) of *

Current Market Value ($)

Market Price per share

Description

Do you need to add another one?

Par Value or No. of Shares

Registered in Name(s) of *

Current Market Value ($)

Market Price per share

Description

Do you need to add another one?

Par Value or No. of Shares

Registered in Name(s) of *

Current Market Value ($)

Market Price per share

Description

Total Amount:

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SCHEDULE 3 / SECURITIES OWNED - CLOSELY HELD BUSINESSES

Par Value or No. of Shares

Percentage Ownership

Description(s)

Registered in Name(s) of

Do you need to add another one?

Par Value or No. of Shares

Percentage Ownership

Description(s)

Registered in Name(s) of

Do you need to add another one?

Par Value or No. of Shares

Percentage Ownership

Description(s)

Registered in Name(s) of

Do you need to add another one?

Par Value or No. of Shares

Percentage Ownership

Description(s)

Registered in Name(s) of

Total Amount:

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SCHEDULE 4 / LIFE INSURANCE

Insurance Company

Insured

Beneficiary

Face Value of Policy

Cash Value Of Policy

Policy Loans

Do you need to add another one?

Insurance Company

Insured

Beneficiary

Face Value of Policy

Cash Value Of Policy

Policy Loans

Do you need to add another one?

Insurance Company

Insured

Beneficiary

Face Value of Policy

Cash Value Of Policy

Policy Loans

Do you need to add another one?

Insurance Company

Insured

Beneficiary

Face Value of Policy

Cash Value Of Policy

Policy Loans

Do you need to add another one?

Insurance Company

Insured

Beneficiary

Face Value of Policy

Cash Value Of Policy

Policy Loans

Do you need to add another one?

Insurance Company

Insured

Beneficiary

Face Value of Policy

Cash Value Of Policy

Policy Loans

Do you need to add another one?

Insurance Company

Insured

Beneficiary

Face Value of Policy

Cash Value Of Policy

Policy Loans

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SCHEDULE 5 / RECEIVABLES DUE TO ME ON MORTGAGES, NOTES & CONTRACTS I OWN

Name of Debtor

Date of Maturity

Do you need to add another one?

Type and Value of Collateral

Repayment Terms

$ per

First of Second Lien

Balance Due

Name of Debtor

Date of Maturity

Do you need to add another one?

Type and Value of Collateral

Repayment Terms

$ per

First or Second Lien

Balance Due

Name of Debtor

Date of Maturity

Type and Value of Collateral

Repayment Terms

$ per

First Lien or Second Lien

Balance Due

Total $ Amount:

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SCHEDULE 6 / PERSONAL RESIDENCES

Property Description and Address

Name of Creditor

Year or Purchase

Purchase Price

Mortgage Balance ($)

Date Of Maturity

Repayment Terms ($ per)

Current market value ($)

Do you need to add another one?

Property Description and Address

Name of Creditor

Year or Purchase

Purchase Price

Mortgage Balance ($)

Date Of Maturity

Repayment Terms ($ per)

Current market value ($)

Do you need to add another one

Property Description and Address

Name of Creditor

Year or Purchase

Purchase Price

Mortgage Balance ($)

Date Of Maturity

Repayment Terms ($ per)

Current market value ($)

Do you need to add another one

Property Description and Address

Name of Creditor

Year or Purchase

Purchase Price

Mortgage Balance ($)

Date Of Maturity

Repayment Terms ($ per)

Current market value ($)

Total Mortgage Balance ($)

Total Market Value ($)

Insurance Company

Agent

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SCHEDULE 7 / OTHER REAL ESTATE OWNED

Property Type and Address

% Owned

Name of Creditor

Year Acquired

Purchase Price ($)

Mortgage Balance ($)

Date Of Maturity

Repayment Terms

$ per

Current Market Value (% Owned)

Do you need to add another one?

Property Type and Address

% Owned

Name of Creditor

Year Acquired

Purchase Price ($)

Mortgage Balance ($)

Date Of Maturity

Repayment Terms

$ per

Current Market Value (% Owned)

Do you need to add another one?

Property Type and Address

% Owned

Name of Creditor

Year Acquired

Purchase Price ($)

Mortgage Balance ($)

Date Of Maturity

Repayment Terms

$ per

Current Market Value (% Owned)

Do you need to add another one?

Property Type and Address

% Owned

Name of Creditor

Year Acquired

Purchase Price ($)

Mortgage Balance ($)

Date Of Maturity

Repayment Terms

$ per

Current Market Value (% Owned)

Do you need to add another one?

Property Type and Address

% Owned

Name of Creditor

Year Acquired

Purchase Price ($)

Mortgage Balance ($)

Date Of Maturity

Repayment Terms

$ per

Current Market Value (% Owned)

Do you need to add another one?

Property Type and Address

% Owned

Name of Creditor

Year Acquired

Purchase Price ($)

Mortgage Balance ($)

Date Of Maturity

Repayment Terms

$ per

Current Market Value (% Owned)

Do you need to add another one?

Property Type and Address

% Owned

Name of Creditor

Year Acquired

Purchase Price ($)

Mortgage Balance ($)

Date Of Maturity

Repayment Terms

$ per

Current Market Value (% Owned)

Total $:

Insurance Co

Agent

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SCHEDULE 8 / RETIREMENT ACCOUNTS - IRA, 401(K), PROFIT SHARING AND PENSION

Name of Institution or Plan

Type of Account

In whose name?

Amount Totally Vested ($)

Loans ($)

Net Account Balance ($)

Do you need to add another one?

Name of Institution or Plan

Type of Account

In whose name?

Amount Totally Vested ($)

Loans ($)

Net Account Balance ($)

Do you need to add another one?

Name of Institution or Plan

Type of Account

In whose name?

Amount Totally Vested ($)

Loans ($)

Net Account Balance ($)

Do you need to add another one?

Name of Institution or Plan

Type of Account

In whose name?

Amount Totally Vested ($)

Loans ($)

Net Account Balance ($)

Do you need to add another one?

Name of Institution or Plan

Type of Account

In whose name?

Amount Totally Vested ($)

Loans ($)

Net Account Balance ($)

Do you need to add another one?

Name of Institution or Plan

Type of Account

In whose name?

Amount Totally Vested ($)

Loans ($)

Net Account Balance ($)

Do you need to add another one?

Name of Institution or Plan

Type of Account

In whose name?

Amount Totally Vested ($)

Loans ($)

Net Account Balance ($)

Total $:

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SCHEDULE 9 / LOANS PAYABLE TO BANKS & OTHERS AND INSTALLMENT CONTRACTS PAYABLE

To Whom Payable

Interest Rate

Type of Collateral or Unsecured

How payable

Maturity Date

Unpaid Balance ($)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add another one?

To Whom Payable

Interest Rate

Type of Collateral or Unsecured

How payable

Maturity Date

Unpaid Balance ($)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add another one?

To Whom Payable

Interest Rate

Type of Collateral or Unsecured

How payable

Maturity Date (3)

Unpaid Balance ($) (3)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add another one?

To Whom Payable

Interest Rate

Type of Collateral or Unsecure

How payable

Maturity Date

Unpaid Balance ($)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add another one?

To Whom Payable

Interest Rate

Maturity Dat

How payable

Type of Collateral or Unsecured

Unpaid Balance ($)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add another one?

To Whom Payable

Interest Rate

Type of Collateral or Unsecured

How payable

Maturity Date

Unpaid Balance ($)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add another one?

To Whom Payable

Interest Rate

Type of Collateral or Unsecured

How payable

Maturity Date

Unpaid Balance ($)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you need to add another one?

To Whom Payable

Interest Rate

Type of Collateral or Unsecured

How payable

Maturity Date

Unpaid Balance ($)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Total $ Amount:

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SCHEDULE 10 / CREDIT ACCOUNTS, BILLS DUE, ALIMONY/CHILD SUPPORT, DAYCARE, ETC.

Name of Company / Person

Repayment Terms

$ per

Balance Due ($)

Do you need to add another?

Name of Company / Person

Repayment Terms

$ per

Balance Due ($)

Do you need to add another?

Name of Company / Person

Repayment Terms

$ per

Balance Due ($)

Do you need to add another?

Name of Company / Person

Repayment Terms

$ per

Balance Due ($)

Do you need to add another?

Name of Company / Person

Repayment Terms

$ per

Balance Due ($)

Do you need to add another?

Name of Company / Person

Repayment Terms

$ per

Balance Due ($)

Total $:

Additional Comments / Information

Note:

I certify that the information provided in this statement is true, correct and complete. So long as I owe any sums to the bank or remain as a guarantor, endorser, or co-maker on any other obligation with the bank, I agree to give the bank prompt written notice of any change in my name, address, employment, a material change in my financial condition or any information included in this statement, and upon request, I agree to provide the bank with an updated personal financial statement. The bank is authorized to retain this personal financial statement whether or not credit is approved and is further authorized to verify my credit history, to include periodic credit bureau reports, and employment history or any other information in this statement. I understand this application does not obligate the bank to make any loan even if I meet the normal standards the bank considers in determining whether to approve or deny the application.

Applicant Signature

Clear Signature

Co-Applicant's Signature

Clear Signature

Date:

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DEBT SCHEDULE

Term Debt (all store, equipment, working capital, and shareholder loans as well as capitalized leases)

DATE AS OF:

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rat

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Do you have another one to add?

Store Name / #

Corporate Entity

Lender

Loan Start Date

Original Amount

Balance

Payment

Interest Rate

Maturity Date

Collateral

Total Original Amount

Total Balance

Total Payment

Total Interest Rate

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STORE INFO CHART

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed / Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do You Need to Add Another Store?

Store #

Entity

Month & Year Opened

Store Developed or Acquired & Date

Type (In-line, Free Standing, Mall, etc.)

Next Remodel

Lease Expiration

Lease Options?

Address

Address Line 1

Address Line 2

City

State

Zip Code

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