INDIVIDUALS MUST FILL OUT THIS PAGE                      Page 5

BUSINESS NAME:  ____________________________________________________________________________

BUSINESS ADDRESS: __________________________________________________________________________

PHONE NUMBER: (_____) __________________           NUMBER OF YEARS IN BUSINESS:  _________________

INFORMATION ABOUT YOU AND YOUR SPOUSE (IF APPLICABLE):

YOUR NAME:  _______________________________________________      SS#:  _________________________

DATE OF BIRTH:  ___________________        EMPLOYER:  __________________________________________

EMPLOYER ADDRESS:  ________________________________________________________________________

POSITION:  _________________________________       LENGTH OF EMPLOYMENT:  ______________________

ANNUAL INCOME:  ___________________________

SPOUSE’S NAME:  ____________________________________________     SS#:  _________________________

DATE OF BIRTH:  ___________________        EMPLOYER:  __________________________________________

EMPLOYER ADDRESS:  ________________________________________________________________________

POSITION:  _________________________________       LENGTH OF EMPLOYMENT:  ______________________

ANNUAL INCOME:  ___________________________

HOUSEHOLD ADDRESS:  _______________________________________________________________________

RESIDENCE TYPE:          RENT __________           OWN/BUYING __________             BOARDING __________

ARE THERE ANY UNSATISFIED JUDGMENTS AGAINST YOU?  __________________________________________

HAVE YOU EVER DECLARED BANKRUPTCY:                YES _______________             NO ________________

AMOUNT OF CREDIT REQUESTED:  ____________________       COST OF PROJECT:  ____________________

DO YOU PLAN TO GET A BANK LOAN? ___________________________________________________________

IF YES, NAME OF BANK ______________________________________________

LOAN OFFICER: __________________________________            PHONE NUMBER: (_____) ________________