TO BE FULLY COMPLETED BY ALL APPLICANTS           Page 2

PRINCIPAL CHECKING ACCOUNT IS HELD AT:  _____________________________________________________

OFFICE LOCATION: ___________________________________________________________________________

ACCOUNT NUMBER: ____________________________              PHONE #:  ____________________________

THE PRINCIPAL LENDER TO THE BUSINESS IS:  ____________________________________________________

ADDRESS: __________________________________________________________________________________

TOTAL LOANS: ________________________________               PHONE #:  ____________________________

DO THESE LOANS INCLUDE A LINE OF CREDIT? ____________    IF YES, AMOUNT:  ______________________

PLEASE PROVIDE THE THREE (3) MAJOR BUSINESS REFERENCES:

BUSINESS NAME: _____________________________________________________________________________

ADDRESS: __________________________________________________________________________________

PHONE NUMBER (_____) _______-_________              CONTACT (& TITLE):  ___________________________

BUSINESS NAME: _____________________________________________________________________________

ADDRESS: __________________________________________________________________________________

PHONE NUMBER (_____) _______-_________              CONTACT (& TITLE):  ___________________________

BUSINESS NAME: _____________________________________________________________________________

ADDRESS: __________________________________________________________________________________

PHONE NUMBER (_____) _______-_________              CONTACT (& TITLE):  ___________________________

I/WE READ AND UNDERSTAND THE CREDIT TERMS SET FORTH HEREIN AND AUTHORIZE STONE & COMPANY  TO OBTAIN INFORMATION FROM THE REFERENCES LISTED IN THIS APPLICATION OR BY CREDIT BUREAU REPORT. 

DATE:  ______________     BUSINESS NAME:  _____________________________________________________

SIGNATURE:  __________________________________________________________________________ (SEAL)        

SIGNATURE:  __________________________________________________________________________ (SEAL)