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    NCDFI LOAN APPLICATION – Part I – BUSINESS

    $45.00 Application Fee

    Complete one copy of this form for your business.



















    CHECK AS APPLICABLE: Applicant is applying for this loan:










    Business Ownership

    Please list all owners of the business and percent ownership:



    Business Description
    Type of business(Legal Structure):
    General Description:
    History:
    Business Products and Services:
    Target Market: Primary Market(s)
    • TBD

    		 Market Niche Development
    • TBD
    Competition:
    Management:
    Goals: Short-Term (6 mo. - 1 year)
    • TBD

    		 Mid-Term: (2 - 5 years)
    • TBD

    		 Long-Term (5+ years)
    • TBD
    Unmet Needs:



    Loan Request
    Amount of loan requested: $
    Purpose of loan:
    Application of Funding: Schedule of Unmet Needs Amount
    Total
    Have you applied for a loan with NCDFI before? If yes, date:
    Have you applied for other financing in conjunction with this loan? If yes, where: Were you successful?



    Existing Business Debt
    Lender Loan # (if applicable) Original Loan Amount Interest Rate Loan Start Date Loan End Date Monthly Payment Current Balance



    Collateral

    Please list and describe the business and personal collateral available to secure this loan
    Item Resale Value Is this used as collateral on
    an existing loan?
    Yes/No    		 Existing Debt on Item Item Description



    Additional Required Documentation:

    Please include the following documents with your application in order for the application to be considered complete.

    Items that are attached in this application package:
    Credit Report Authorization and Release for each person filling out the NCDFI Loan Application Part II
    NCDFI Application Part II from all partners with at least 20% ownership, all guarantors, and all co-signers

    Supplemental Items:
    Yes Personal taxes for the past three years for each partner with at least 20% ownership, all guarantors, and all cosigners.
    Yes Internally prepared income statement and balance sheet for the business for the last three fiscal years.
    Yes Internally prepared income statement and balance sheet for the current year through the previous month (including year-to-date totals)
    Yes Accounts Receivable Aging report (if Accounts Receivable will be used as collateral)
    Yes Business Plan
    Yes 12-months of business cash flow projections
    Yes Business taxes for previous three years
    Yes Copies: Each principal’s tribal enrollment card and each principal’s driver’s license
    Yes Resumes of key personnel
    Yes Corporate Documents:

    • Corporation: Articles of Incorporation and Bylaws
    • Partnership: Partnership Agreement
    • LLC and LLP: Operating Agreement
    Yes Application Fee - $45


    If you have any questions about the above items or if you need assistance, please contact NCDFI’s CEO or lending department.


    I hereby authorize NCDFI to make all inquiries it deems necessary to verify the accuracy of the information provided herein, to determine my credit-worthiness, and for any other purpose related to my credit transaction with them. Further, I hereby certify that the enclosed application information, including any attachments/exhibits, is valid and correct to the best of my knowledge.




    NCDFI practices equal treatment of clients. NCDFI does not discriminate on the grounds of race, color, religion, gender, marital status, disability or national origin in services or accommodations offered to our clients or guests.


    NCDFI LOAN APPLICATION – Part II

    OWNERS, CO-APPLICANTS and GUARANTORS

    Part II of NCDFI’s loan application must be completed individually by each owner with 20% or more ownership. In addition, each guarantor and co-signer must individually complete this section of the application. If additional copies of the NCDFI Loan Application Part II are needed, this section can be photocopied.




































    Navajo CDFI does not discriminate on the basis of marital status, this information will be used to assess collateral and guarantees



    Personal Financial Statement

    Please fill out the following summary information. The 12 schedules following this chart ask for detailed information about each line item below. Please make sure that the detailed information total from each of the 12 schedules matches in numbers entered in this chart.

    ASSETS

    LIABILITIES
    Cash on Hand $ Accounts and Bills Payable (Complete Schedule I) $
    Cash in Bank Accounts (Complete Schedule A) $ Debt on Real Estate (Describe in Schedule J) $
    IRA or Other Retirement Account (Complete Schedule B) $ Notes and Loans Payable (Describe in Schedule K) $
    Accounts and Notes Receivable (Complete Schedule C) $ Unpaid Taxes and Other Liabilities (Describe in Schedule L) $
    Cash Value of Life Insurance $_________ (Complete Schedule D) $ TOTAL LIABILITIES $
    Stock and Bonds (Describe in Schedule E) $
    Real Estate (Describe in Schedule F) $
    Privately Owned Businesses (Describe in Schedule G) $
    Total Other Assets (Describe in Schedule H) $ NET WORTH (TOTAL ASSETS LESS TOTAL LIABILITIES) $
    TOTAL ASSETS $ TOTAL LIABILITIES PLUS NET WORTH $

    PLEASE INDICATE OR PROVIDE EXPLANATION RELATING TO ANY ASSETS OWNED JOINTLY OR BY A TRUST OR LIABILITIES OWED WITH OTHERS. (ATTACH SCHEDULES AND EXPLANATORY NOTES IF NECESSARY)


    Detailed Schedules for the Personal Financial Statement


    Schedule A Cash Location, Status of Bank Accounts and Savings Accounts
    CKNG CDs SVNG Bank/Branch where carried Balance Interest Rate Date CD Matures Pledged for a loan? Balance of loan Maturity date of loan
    TOTAL:

    * Alimony, child support or maintenance payment income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.



    Schedule B Retirement Accounts
    Account Type Investment Company Balance Pledged for a loan? Balance of loan Maturity date of loan Account fully vested?
    TOTAL:



    Schedule C Accounts and Notes Receivable
    Owner(s) Due From Address Collateral maturity-date-of-loan-4 How Payable ($/per) Balance due
    TOTAL:



    Schedule D Life Insurance
    Insurance Company Policy# Type Owner Face Amount of Policy Beneficiar Amount Net Cash Value Borrowed
    TOTAL:



    Schedule E Stocks & Bonds (Include interest in any closely-held business)
    Description No. Shares Registered in Name of Source of Valuation Date Price per Share Total Value Purchased on Margin or Pledged
    TOTAL:



    Schedule F Real Estate
    Description Address/Location Owner(s) Date Acquired Purchase Price Present Value
    TOTAL:



    Schedule G Privately-owned Business
    Name/Type of Business Date Acquired % Owned Gross Revenue Three Years Net Profit Three Years Cost Market Value
    TOTAL:



    Schedule H Automobiles, Other Assets and Personal Property
    Automobiles (Year/Make) Value Recreational Vehicles/Boats (Year/Make) Value Personal Property Value Subtotals
    Furniture Autos
    Jewelry RVs/Boats
    Equipment Pers. Property
    Other
    Other
    SUBTOTAL SUBTOTAL SUBTOTAL TOTAL:



    Schedule I Accounts and Bills Payable (including Credit Cards)
    Payable to Account Number Person(s) Liable How Payable ($/per) Balance due
    TOTAL:



    Schedule J Debt on Real Estate
    Description Payable to Payment Date of Loan Original Balance Balance due
    TOTAL: TOTAL:



    Schedule K Notes and Loans Payable (Auto, Installment Loans, Life Ins., 401K)
    Payable to Address Collateral Person(s) Liable Maturity Date How Payable ($/per) Balance due
    TOTAL:



    Schedule L Tax and Other Liabilities
    Payable to Person(s) Liable Collateral How Payable($/per) Balance due
    TOTAL:



    Monthly Personal Financials
    Income Amount $ Expenses Amount $
    Salary/Owner draws from Business Education and Childcare
    Spouse’s Income Food and Clothing
    Applicant’s other Employment Income Child Support / Alimony
    Any other Income (per cap, etc.) Home Rent / Mortgage
    TOTAL: Utilities
    Auto (Insurance, Fuel, Maintenance)
    Credit Card Payments
    Other Loan Payments
    Other:
    Other:
    TOTAL:



    Business and Personal References (Non-Family)
    Name Address Phone Relationship
    Point of Contact of closest relative not living with you:
    Name Address Phone Relationship



    Please attach a list explaining any unsatisfactory accounts that may appear on your credit report.

    I hereby authorize NCDFI to make all inquiries it deems necessary to verify the accuracy of the information provided herein, to determine my credit-worthiness, and for any other purpose related to my credit transaction with them. Further, I hereby certify that the enclosed application information, including any attachments/exhibits, is valid and correct to the best of my knowledge




    NCDFI practices equal treatment of clients. NCDFI does not discriminate on the grounds of race, color, religion, gender, marital status, disability or national origin in services or accommodations offered to our clients or guests.



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