Application InformationApplication IDIn this Business Services Application, the words "We", "Us", and "Our" mean Rising Tide Community Loan Fund and the words "You" and "Your" mean the Applicant(s)Date* MM slash DD slash YYYY Annual SalesAccount Number Application Taken By: Branch Request* New Renewal Increase Loan Amount Requested*Terms of Repayment Use of Proceeds* What Collateral do You offer in support of the credit request? (If Real Estate, please provide copy of a legal description of the property and the most recent tax statement.)* Guarantors of Credit* Company/Applicant InformationLegal Name of Company/Appllicant Name* Primary Contact* Email* Tax ID Number* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office Property Status* Own Rent Other Type of Credit Applied For:* Unsecured Business Line of Credit Secured Business Line of Credit Unsecured Business Term Loan Secured Business Term Loan Business Telephone*FaxType of Business* Time in Business* Number of Employees*Time Under Current Management* Business Entity* Sole Proprietorship Partnership Corporation Limited Partnership General Partnership Limited Liability Company Not-for-Profit Other Limited Liability Partnership Principals/Owners*Name% OwnershipTitle Banking Relationships (Please list only your business accounts)*Bank NameAccount NumberCheckingSavingsLoanCurrent Balance Business/Trade References (Please list your two major suppliers or references)*NameAddressName of ContactPhone Number Miscellaneous (Please provide details below if you answer YES to any of the following questions)Is the business a party to any claim or lawsuit?* Yes No Has the business ever declared bankruptcy?* Yes No Bankruptcy DetailsChapterDate of filing Are any of the applicants an endorser, guarantor, or co-maker for obligations not listed on the financial statements?* Yes No if YES, please indicate total contingent liability:DetailsSignaturesYou certify that all statements in this Application and on each document required to be submitted in the connection herewith, including federal income tax returns, are true, correct and complete. You authorize Us to make such inquires and gather such information as We deem necessary and reasonable concerning any information provided to Us on this Application or on any such required document, including inquiries to the Internal Revenue Service. You further agree to notify Us promptly of any material change in any such information. You authorize Us to accept Your online signatures on this application and, subsequently, on any other documents associated with the credit for which You are applying and You agree that Your online signature will have the same legal force and effect as Your original signature. You assume any risk that may be associated with permitting Us to accept your online signature.SignatureSignature Title and DetailsCompany NameIndividuals/OwnersTitleDate Δ
