Incorporated under the Navajo Nation

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.