Small Business Loan Checklist

(Loan Exposure up to $1,000,000(1))

(Line of Credit up to $500,000)
Please complete, sign and date all documentation and financial information and submit a
complete loan package to prevent any unnecessary delays in your application.

I. Required for all Small Business Loan Applications:

Small Business Loan Application (Bank form)

Personal Financial Statement (Bank form) for all Owners with greater than 10% ownership

Business’ Bank statements for the last 3-months on all Business accounts

Copy of invoice, contract or proposal if loan is used to purchase equipment, vehicle or real estate

(1)
II. Required for all Small Business Loan Applications with loan exposure greater than $150,000:

Business Federal Tax Returns: Last 2 years complete with all Schedules
(CPA Audited or Reviewed statements may be substituted)

Fiscal Year End Financial Statement (Business prepared): required if current tax return is not yet filed

Year to Date Profit & Loss Statement (Business prepared): required if applying more than 6-months
after Business’ fiscal year end

Personal Federal Tax Returns: Last 2 years complete with all Schedules for all Owners with greater
than 10% ownership interest. (Include all K-1 statements for businesses identified on Schedule E and all
supporting statements attached to the return)

All Small Business Loan payments require automatic debit from the Business/Borrower’s checking
account with Bank.

Evidence of business and/or real estate property insurance coverage will be required to support loan
request.

Entity Documentation will be required at deposit account opening and/or prior to loan closing.

(1)
Total loan exposure includes all commercial loans, leases, letters of credit and investment mortgages to all related parties with
Bank plus current loan request. Other obligations may also be included in loan exposure at the discretion of the Bank.

If Total Loan Exposure is less than or equal to $150,000 please provide above required information under Section I.
If Total Loan Exposure is greater than $150,000 then please provide above required information under Sections I. and II.

Bank may request additional documentation and financial information deemed necessary.

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 Bank Use Only: Branch:

Date: Contact:

Small Business Loan Application

Loan Exposure up to $1,000,000
Line of Credit up to $500,000
Loan Request
Business Loan Amount Requested: Term Requested:
Purpose: $
Collateral to be pledged: At a minimum, loans will be secured by All Business Assets unless other specific assets acceptable to the Bank are pledged.
All Business Assets Real Estate Other: Yes No
Existing liens on business assets?
If yes, please describe:

If Real Estate is used for collateral, please complete:

Property Owner(s):

Street: City: State: Zip:

Existing Mortgage(s): 1st Lien 2nd Lien Other Explain: __________________ Lot(s): ____________ Block(s): ________

Borrower’s
’ Business Information
Type of Organization: Sole Proprietorship Limited Liability Company Corporation Not-for-Profit
(Select one) General Partnership Limited Liability Partnership Sub S Corporation Other:__________________________
_
Legal Name: Tax ID: State where Organized:

DBA Name: Business Start Date: Present Owner Start Date:

Current Address: City: State: Zip Code:

Mailing Address: City: State: Zip Code:

Business Telephone: Business Fax: Business Website / Email

Business Description: # Current Employees:

Your customers pay you by (choose all that apply): Cash Credit C.O.D. Terms - Define:_____________________________________

This section must be completed: FYE FYE Sales FYE

Fiscal Year End (FYE) Date: _____/_____/______ or Revenue: $ Net Income: $
Management / Ownership: (Individuals with greater than 10% ownership are required to guaranty & submit financial Information)
Name Title Salary Ownership% U.S. Citizen (circle)
Yes / No
Yes / No
Yes / No
Yes / No
Business Financial Information: Do you currently have accounts with Bank? Yes No

Deposits (Checking / Savings / Money Market / CDs):

Deposit Type Bank Name Current Balance Average 12 Month Balance
$
$
$
Loans (Term / Line of Credit / Mortgage / Trade Credit / Bank Card / Other):
Creditor Type Collateral Credit Limit Balance Monthly Pmt Rate Maturity
$ $ $
$ $ $
$ $ $
Attach additional sheets if necessary. TOTAL $ $ $
(See next page for disclosures & signatures)

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 Small Business Loan Application
Applicant Name: _____________________________________

Disclosures
Is the Business in the process of a sale or Yes (explain below)
Is the Business involved in any pending Yes (explain below) No
No
change of ownership? litigation or subject to outstanding judgments?
Is the Business contingently liable as a Yes (explain below) No
Are any of the Business’ tax returns being Yes (explain below) No
guarantor on any other obligations? contested or audited?

Has the Business ever declared Yes (explain below) No

Does the Business have any international Yes (explain below) No
bankruptcy? subsidiaries/affiliates, customers or suppliers?

Has the Business incurred a loss in the Yes (explain below) No

Is the Business involved with any type of Yes (explain below) No
last 3 years? gambling activity?
Is the Business delinquent on any debt Yes (explain below) No Is this an Internet based business? Yes (explain below) No
including loans, payables, or taxes?
Does the Business provide or have on their premises any of the following Money Services (please check all that apply and indicate issuer under Explanation);
____ ATM ____ Check Cashing ____ Funds Transfer ____ Money Orders ____ Prepaid / Stored / Gift Cards ____ Travelers Checks

Explanation(s):

Applicant Notices
USA Patriot Act: In accordance with Section 326 of the USA Patriot Act, all persons and business entities are subject to identity verification requirements. If
you request to open an account (any formal banking relationship, including deposits, loans, safe deposits, trusts, etc.), the Bank will request documentary
verification on your identity and will perform appropriate background checks in compliance with the Act.

Right to Request Specific Reasons for Credit Denial Given at the Time of Application: If your application for business credit is denied, you have the
right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Provident Bank as successor by merger to
Lakeland Bank, Small Business Lending Department, 250 Oak Ridge Road, Oak Ridge, New Jersey, 07438-8906 within 60 days from the date you are
notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

Equal Credit Opportunity Act: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of
race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of
the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the
Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is: FDIC Consumer Response
Center, 1100 Walnut Street, Box # 11, Kansas City, Missouri 64106.

Notice of Right to Copy of an Appraisal: If your application is secured by a first lien on a 1-4 family dwelling: We may order an appraisal or written
valuation to determine the property’s value and charge you for this appraisal or written valuation. We will promptly give you a copy of any appraisal
or written valuation, even if your loan does not close. You can pay for an additional appraisal for your own use at your own cost.
Applicant Acknowledgment, Certification and Authorization
This information and the information provided on all accompanying financial statements and schedules is provided for the purpose of obtaining credit for the
Applicant(s) or for the purpose of Applicant(s) guaranteeing credit for others. Applicant(s) acknowledge that representations made in this statement will be
relied on by Creditor in its decision to grant such credit. This statement is true and correct and accurately represents the financial condition of the
Applicant(s) on the date given below. Creditor is authorized to make all inquiries it deems necessary to verify the accuracy of the information contained
herein and to determine the creditworthiness of the Applicant(s). The undersigned authorize any person, entity or consumer reporting agency to give you
any information it may have on the undersigned. Applicants will promptly notify the Creditor of any subsequent changes which would materially affect the
accuracy of this statement. Applicant(s) are aware that any knowing or willful false statements regarding the value of the above property for purposes of
influencing the actions of Creditor can be a violation of federal law, and may result in a fine or imprisonment or both. Applicant(s) have received a copy of
the Equal Credit Opportunity Notice.
Signature(s)
As an authorized agent for the Applicant, I/we confirm that I/we have read fully and understand this Application and its Notices, Acknowledgements,
Certifications and Authorizations and concur with all.

Signature: Date:
Title

Signature: Date:
Title

Signature: Date:
Title

Signature: Date:
Title

Equal Housing, Equal Opportunity Lender, Member FDIC

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 Personal Financial Statement as of:

Small Business Loan Application (Loans up to $1,000,000)

Personal Information
Co-Applicant Definition: If two Owners / Guarantors own joint assets and share joint liabilities (i.e. you and your spouse), you need only fill out one Personal Financial Statement,
utilizing both “Applicant” and “Co-Applicant” sections. Owners / Guarantors who share business interests only; please fill out a separate Personal Financial Statement.
Applicant Name: Co-Applicant Name:

Home Address (Street/City/State/Zip): Own Rent Home Address (Street/City/State/Zip): Own Rent

Home Phone No. Social Security No. Date of Birth: Home Phone No. Social Security No. Date of Birth:

Mobile Phone No. Email Address: U.S. Citizen? Mobile Phone No. Email Address: U.S. Citizen?

Employer: Employer:

Address of Employer (Street/City/State/Zip): Address of Employer (Street/City/State/Zip):

Business Phone No. No. of years with Title / Position: Business Phone No. No. of Years with Title / Position:
employer? Employer?

Name of previous employer & position (if with current employer less than 3 yrs) No. of Yrs Name of previous employer & position (if with current employer less than 3 yrs) No. of Yrs

Important: _____ Check here and initial if you intend to apply for credit jointly. Applicant initials __________ Co-Applicant initials __________

Balance Sheet
ASSETS Amount ($) LIABILITIES AMOUNT ($)
Cash on Hand and at Banks $ Loans Outstanding to this Bank $
Listed and Government Securities (Schedule A) Loans Outstanding to Other Banks/Financial Institutions
Unlisted Securities (Schedule A) Accounts Payable (Including Credit Cards)
Retirement Accts (IRA, 401K, Profit-Sharing & Other Vested Accts) Real Estate Loans – Primary Residence (Schedule B)
Primary Residence (Schedule B) Real Estate Loans – Investment Property (Schedule B)
Real Estate Investments (Schedule B) Auto Loans / Leases
Business Interests Education Loans
Net Cash Surrender Value of Life Insurance (Schedule C) Life Insurance Loans (Schedule C)
Personal Property (Including Automobiles) Margin or Retirement Account Loans
Other Assets Other Debt
Total Liabilities $
Net Worth (Total Assets – Total Liabilities) $
Total Assets $ Total Liabilities + Net Worth $

Income & Expense Statement

Annual Income* Amount Amount Annual Expenses** Amount Amount
(Applicant) (Co Applicant) (If Applicable) (Applicant) (Co Applicant)
Salary $ $ Rental Payments $ $
Bonus and Commissions Co-Op or Condo Maintenance
Dividends Alimony, Child Support, Maintenance
Real Estate Income Tuition
Other Income (List) Other Expenses (List)

Total Income $ $ Total Expenses

*You need not disclose alimony, child support or separate maintenance income unless you wish the **Expenses are not representative of total annual expenses. They are for additional information only.
Bank to consider them in a credit decision.

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 Personal Financial Statement Applicant Name:

Contingent Liabilities & Disclosures Applicant Co-Applicant

Are you a guarantor, co-maker or endorser for any debt of an Individual, No
Yes (explain below) No Yes (explain below)
corporation or partnership?
Is any of your personal debt being paid by the business? Yes (explain below) No Yes (explain below) No

Are you involved in any pending litigation or subject to outstanding judgments? Yes (explain below) No Yes (explain below) No

Have you ever filed for Bankruptcy? Yes (explain below) No Yes (explain below) No

Are you delinquent on any debt, including loans, credit cards, income tax or real Yes (explain below) No Yes (explain below) No
estate tax obligations?
Are any tax returns being contested or audited? Yes (explain below) No Yes (explain below) No

Do you have any other contingent liabilities (leases, letters of credit, surety bonds, Yes (explain below) No
Yes (explain below) No
etc.) or are you obligated to pay alimony and/or child support?
Explanation(s): (Attach additional sheets if necessary)

Schedule A: U.S. Government, Listed and Unlisted Securities (Attach additional sheets if necessary)
Description & Type Legal Owner No. Shares or Face Market Value
Value of Bonds

Schedule B: Primary Residence & Real Estate Investments (Attach additional sheets if necessary)
Property Address Legal Owner Purchase Market Value Loan Balance Rate Maturity Monthly
Year Price Date Payment

Schedule C: Life Insurance (Attach additional sheets if necessary)

Insurance Company Face Amount Beneficiary Cash Surrender Amount Owner
of Policy Value Borrowed

Representations and Warranties

The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guarantee of the
undersigned. The undersigned acknowledge and understand you are relying on the information provided herein in deciding to grant or continue credit or to accept a guarantee
thereof. Each of the undersigned represents, warrants and certifies the information provided herein is true, correct and complete. Each of the undersigned agrees to notify you
immediately and in writing of any change in name, address or employment and of any material adverse change (1) in any of the information contained in this statement or (2) in any
financial condition of any of the undersigned or (3) in the ability of any of the undersigned to perform his/her (or their) obligations to you. In the absence of such notice or a new and
full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail to notify you as required above, or if any of the information
herein should prove to be inaccurate or incomplete in any material respect, you may declare the indebtedness of the undersigned or the indebtedness guaranteed by the
undersigned, as the case may be, immediately due and payable. You are authorized to make all inquiries you deem necessary to verify the accuracy or the information contained
herein and to determine the credit-worthiness of the undersigned. The undersigned authorize any person, consumer reporting agency or entity to give you any information it may
have on the undersigned. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned. As long as any obligation or guarantee of
the undersigned to you is outstanding, the undersigned shall supply annually an updated financial statement. This personal financial statement and any other financial or other
information the undersigned give you shall be your property.

Applicant’s Signature: Date:

Co-Applicant’s Signature: Date:

Co-applicant signs, if you are requesting to apply jointly, be sure you checked and both initialed under Personal Information

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