Community Bank Wheaton / Glen Ellyn

	357 Roosevelt Road - Glen Ellyn 100 North Wheaton Avenue - Wheaton 370 South County Farm Road - Wheaton
COMPANY INFORMATION

Company Legal Name

d/b/a or Trade Name

(if different)

Street Address

City, State, Zip

Mailing Address

(if different)

City, State, Zip

Business Phone

(include area code)

Fax Number

(include area code)

Federal Tax Id Number

E-mail Address

Type of Organization

If other, please specify

Industry / Business Type

If Other, please specify

Annual Revenues ($)

Date Established

(mm/dd/year)

Current Ownership Since

Number of Employees

Description of Business (including competitive advantages)

Does the company, or do owners of the company, have ownership interest(s) in any other business?	Yes No
If yes, please list:

Company Name(s)

Percentage of Ownership

Does the company have any additional business locations?	Yes No
If yes, list addresses:

Has your business or have any principals of the business been involved in a bankruptcy?	Yes* No
Is your business or any principals of the business currently involved in any pending judgments, claims or lawsuits?	Yes* No
Does your business have any tax or employee payments which are delinquent or in dispute?	Yes* No

*If you answered yes to any of the questions listed above, please explain below:

Ownership / Management Information: (list all owners of the Company)

Name	S.S. Number	Title	% of Ownership	Number of Years in this Business

Business Accounts (Non-Community Bank Wheaton / Glen Ellyn only)

Bank / Broker Name	Account Type	Account Number	Balance	Date Opened (mm/dd/year)

Business Indebtedness (Non-Community Bank Wheaton / Glen Ellyn only)

To Whom Payable	Original amount ($)	Current Balance ($)	Annual Payment ($)	Interest Rate %	Collateral Pledged

Loan Request Information

Type of Loan Requested		Loan Request Amount	Requested Term	Use of Proceeds
	Commercial Line of Credit
	Commercial Installment Loan
	Commercial Real Estate Loan
	Commercial Letter of Credit
	Commercial Lease

Describe Collateral:

I choose to take advantage of an automatic payment	Yes No
If yes, CBWGE Account #

Real Estate Loan Requests Only

If the loan will be secured by real estate, please provide the following information:

Property Type	Retail	Warehouse
	Office	Multi-Family
	Industrial	Residential

Do you currently own this property? Yes No

Percent Occupied by Business:

Property titled, or to be titled in the name(s) of

Is (Will) title to this
property be held in a

Land Trust Living Trust N/A

Trustee Name:

Trustee Phone Number

Property Address

Year Constructed

Square Feet

Number of Units

Possible environmental concerns? Yes No

If yes, describe:

Legal / Professional Information

Business Account		Phone
Business Attorney		Phone
Business Insurance Agent		Phone
Realtor (if applicable)		Phone

Needed Information to Process Loan Request

	Personal Financial Statement (for all principals)		Latest business, interim financial statements
	Business tax returns - past three years		Personal tax returns - past three years
	FYE balance sheet and income stmt (past three years)		Accounts Receivable / Payable Agreements
	Collateral documentation		Certified copy of Trust Agreement
	Copy of an old appraisal / environmental report		Insurance Information
	Copy of all leases (real estate loan only)		Income stmt. on income property - 3 years
			(real estate loan only)

Credit References (minimum one)

1.	Name of Business
	Contact Name
	Contact Phone Number	(include area code)
	Address
	City, State, Zip

2.	Name of Business
	Contact Name
	Contact Phone Number	(include area code)
	Address
	City, State, Zip

Banking History

1.	Name of Bank	2.	Name of Bank
	Account Type		Account Type
	Account Number		Account Number
	Bank Officer		Bank Officer
	Phone Number		Phone Number
	Address		Address
	City		City
	State, Zip		State, Zip

Right to Privacy Information

Your trust is the cornerstone of our relationship. That is why we work diligently to safeguard your privacy. The information that you provide us is kept in the strictest confidence. We have no intentions of selling personal or business information about our customers to third-party businesses. We do NOT disclose any information about you to anyone, except as permitted by law. Please refer to our Right to Privacy brochure titled, Your Right to Privacy: Important Information To Know available at both Bank location or by mail.

CERTIFICATION

The undersigned certified that all the statements in this Company Information sheet and on each of the documents submitted with the Company Information sheet are true and complete. The undersigned authorizes Community Bank-Wheaton / Glen Ellyn to make the necessary and reasonable inquiries regarding the information provided. NOTICE: 18 United States Code 1014, prescribes criminal penalties for false statements in loan applications to federally insured banks. The undersigned acknowledges that all supporting information included in this Company Information sheet will remain the property of Community Bank-Wheaton / Glen Ellyn. The undersigned further agrees to notify Community Bank-Wheaton / Glen Ellyn of any material changes in the information provided. CBWGE is hereby authorized to make all inquiries deemed necessary to verify the accuracy of the statements made herein, and to determine credit worthiness, including, but not limited to procuring consumer and business reports from reporting agencies and credit information from banks and other financial institutions and extenders of credit references, present and former employers, merchants, landlords, creditors and vendors.

To apply, print this completed application and fax, mail or bring it to any of our locations.