Name

Personal Information

Home Address

City

State

Zip Code

E-mail Address

Phone Number

Mobile Number

Your social security number is required to run a credit report.

Social Security #

Initial Interest

Are you… New to businessOwner of a start-up (open less than a year)Owner of an established business

Referral: How did you hear about BiGAUSTIN? BankBiG ClientBiG StaffFriendInternetJob FairMailingNewspaperOther AgencyPostersRadioStakesWalk-InWord of Mouth

Please specify whom or which

Business Information

Business Name

% Ownership

Description of Business

Business Address

City

State

Zip Code

County

Phone Number

Fax Number

Web Site

Startup Date

Legal Entity Sole proprietorPartnershipCorporation

Loan Request

Startups can apply for up to $2,500 without a comprehensive business plan, up to $15,000 with comprehensive plan; established businesses can apply for up to $50,000 (minimum one year of sales and filed business income tax return).

Amount Requested

Purpose Working capitalInventoryEquipmentVehicleSuppliesOther

Other purpose

Cash Flow

Total monthly income from ALL household sources

Total monthly household expenses

Average gross monthly sales

Average monthly business expenses

Estimated Personal Assets

Cash on Hand

Savings, checking, stocks, etc.

Real estate and automobile should be total current market value, regardless of what you may owe on them.

Real Estate

Automobile

Other Assets

Estimated Personal Liabilities

Total credit card balance

Total bank/student loan balance

Real estate balance

Auto balance

Other Liabilities

Minimum Criteria Checklist

Have you ever filed for bankruptcy?

If applicable, date of bankruptcy discharge

Do you have any collection actions or unpaid taxes?

Do you have any outstanding police, public, or legal issues?

Are you or the business involved in any lawsuits?

Do you owe any outstanding child support?

Have you ever defaulted on a federal contract or student loan?

Is your business a 501(c)(3) non-profit?

Do you have proof of owner equity/investment?

Do you have a written business plan with 2 years financial projections?

Are you a US citizen, or have a valid green card?

Have you had 3+ months of sales or have contracts for future sales?

Additional Factors

Do you or someone else in your household have a source of income outside the business?

Did your business make a profit last year?

Do you have formal training/experience in the field?

Have you had any NSFs on your bank accounts in the past 3 months? (i.e. bounced checks)

Do you own any real estate other than your homestead?

Are you currently paying on a vehicle?

Is there another person willing to be a guarantor/co-signer?

Will your credit report show you as current with all creditors over the past 2 years?

Have you addressed any derogatory statements on your credit report?

Explanations/Comments

Please explain any negative items above or add other comments

Demographics

The following demographic data are not used in evaluating loan applications; this data is intended for evaluating marketing efforts and for anonymous reporting to funding agencies.

Ethnicity

Gender FemaleMale