Business Financing Questionnaire

Company name:

Mailing Address:

Form:

Type of Business:

Key Contact:

Contact Title:

Phone
Fax
E-mail

Tax ID Number:
Date Established:

No. of Employees Now
Employees in 3 yrs (est.)
Employees in 5 yrs (est.)		 Average Pay of Employees:

Use of Proceeds
Land and/or Buildings
New Building Construction
Leasehold Improvements, Expansion/Repair
Acquisition of Machinery and Equipment
 Inventory Purchase
 Working Capital, Including A/P Payment
 Payoff of SBA Loan
 Payoff of Bank Debt (non SBA)
 Payoff of Other Debt (non SBA)

------------------------
Total Loan Requested

Ownership and Management
List all officers, directors, owners, partners and key managers. 100% ownership must be shown. Attach additional information to a separate e-mail if necessary.
Name Title % Owned Compensation
Business Service and Advisors
Bank of Business Account
 CPA Firm
Acct Officer
 Phone
 CPA Contact
 Phone
Bank Branch Address
 CPA Firm Address
If this business, its officers or directors, or any 20% or more owner also owns or has a controlling interest in any other business, provide their names and the relationship with your company along with a current balance sheet and operating statement for each. Attach additional documents to a separate e-mail message if necessary.
If you buy from, sell to, or use the services of any concern in which any officer, director, key manager, or 20% or more owner of this company has a significant financial interest, provide details here. Attach additional documents to a separate e-mail message if necessary.
If you or any officers of this company have ever been involved in bankruptcy or insolvency proceedings, provide details here. Attach additional documents to a separate e-mail message if necessary.
If any officer, director, key manager, or 20% or more owner of this company is presently under indictment or on parole or probation, provide details here. Attach additional documents to a separate e-mail message if necessary.
If you or your business are involved in any pending lawsuits, provide details here. Attach additional documents to a separate e-mail message if necessary.

Personal Histories
Please provide the following information for every officer, director, owner of 20% or more of the company and any other person who has authority to speak for and commit the company in the management of the business:

Name 1 Former Names & Dates used US Citizen SSN or
Alien Reg. No.
Yes No
Date of Birth
 Place of Birth
 Home Phone
E-mail address
Home Address & Dates There
 Home Address & Dates There
Name 2 Former Names & Dates used US Citizen SSN or
Alien Reg. No.
Yes No
Date of Birth
 Place of Birth
 Home Phone
E-mail address
Home Address & Dates There
 Home Address & Dates There
Name 3 Former Names & Dates used US Citizen SSN or
Alien Reg. No.
Yes No
Date of Birth
 Place of Birth
 Home Phone
E-mail address
Home Address & Dates There
 Home Address & Dates There
Name 4 Former Names & Dates used US Citizen SSN or
Alien Reg. No.
Yes No
Date of Birth
 Place of Birth
 Home Phone
E-mail address
Home Address & Dates There
 Home Address & Dates There
Name 5 Former Names & Dates used US Citizen SSN or
Alien Reg. No.
Yes No
Date of Birth
 Place of Birth
 Home Phone
E-mail address
Home Address & Dates There
 Home Address & Dates There
How did you hear about us?

 

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Commerce Capital, L.P.
 5115 Maryland Way
Suite 304
Brentwood, TN 37027
615.244.1432
Fax: 615.242.1407
E-mail: info@commercecap.com