BUSINESS CREDIT APPLICATION
Applicant Information
Applicant Name	{field:applicant_name}
Date of Birth	{field:date_of_birth}
Doing Business As (dba)	{field:doing_business_as_dba}
Tax ID Number	{field:tax_id_number}
Driver’s License #	{field:driver_s_license}
DOL Issue Date	{field:dol_issue_date}
State of Issuance	{field:state_of_issuance}
DOL Expiration Date	{field:dol_expiration_date}
Physical Address	{field:physical_address}
City	{field:pa_city}
State	{field:pa_state}
Zip	{field:pa_zip}
Mailing Address	{field:mailing_address}
City	{field:ma_city}
State	{field:ma_state}
Zip	{field:ma_zip}
Phone	{field:applicant_phone}
Email	{field:applicant_email}
Website	{field:applicant_website}
Type of Business	{field:type_of_business}
Product or Service	{field:product_or_service}
Business Structure	{field:business_structure}
Year Business Est.	{field:year_business_est}
Current Ownership Since	{field:current_ownership_since}
Annual Gross Revenue	{field:annual_gross_revenue}
Number of Employees	{field:number_of_employees}
Fiscal Year End	{field:fiscal_year_end}

PRIMARY CONTACT
Please list the person who will be the primary point of contact between the Applicant and JST Capital.
Name	{field:pc_name}
Title	{field:pc_title}
Mailing Address	{field:pc_mailing_address}
City	{field:pcma_city}
State	{field:pcma_state}
Zip	{field:pcma_zip}
Phone	{field:pc_phone}
Email	{field:pc_email}
Cell	{field:pc_cell}

PRINCIPAL OWNERSHIP OF APPLICANT
Please list all ownership with >20% interest in the Applicant if the Applicant is a business entity.
Name	{field:po_name1}
Title	{field:po_title1}
Social Security Number	{field:po_social_security_number1}
Physical Address	{field:po_physical_address1}
City	{field:po_city1}
State	{field:po_state1}
Zip	{field:po_zip1}
Phone	{field:po_phone1}
Email	{field:po_email1}
Percentage Ownership	{field:po_percentage_ownership1}
Name	{field:po_name2}
Title	{field:po_title2}
Social Security Number	{field:po_social_security_number2}
Physical Address	{field:po_physical_address2}
City	{field:po_city2}
State	{field:po_state2}
Zip	{field:po_zip2}
Phone	{field:po_phone2}
Email	{field:po_email2}
Percentage Ownership	{field:po_percentage_ownership2}

KEY EMPLOYEES
Please list Corporate Officers, Managers and Key Employees regardless of ownership.
Name	{field:ke_name1}
Title	{field:ke_title1}
Years in Industry	{field:ke_years_in_industry1}
Years with Company	{field:ke_years_with_company1}
Responsibilities	{field:ke_responsibilities1}
Name	{field:ke_name2}
Title	{field:ke_title2}
Years in Industry	{field:ke_years_in_industry2}
Years with Company	{field:ke_years_with_company2}
Responsibilities	{field:ke_responsibilities2}

PROFESSIONAL CONTACT INFORMATION
Accountant	{field:accountant}
Phone	{field:pc_phone1}
Email	{field:pc_email1}
Insurance Agent	{field:insurance_agent}
Phone	{field:pc_phone2}
Email	{field:pc_email2}
Attorney	{field:attorney}
Phone	{field:pc_phone3}
Email	{field:pc_email3}
Broker/Realtor	{field:broker_-_realtor}
Phone	{field:pc_phone4}
Email	{field:pc_email4}
Other	{field:pc_other}
Phone	{field:pc_phone5}
Email	{field:pc_email5}

BUSINESS CREDIT HISTORY
If Yes, then please provide additional information or documentation at the bottom of this page. Attach a separate page, if necessary.
Has the Applicant or any Principal filed for bankruptcy or defaulted on any debts in the past 10 years?	{field:bch1}
Has the Applicant or any Principal been involved in any lititgation or other legal claims in the last five years?	{field:bch2}
Does the Applcant or any Principal owe taxes for prior years that are past due with a governmental agency?	{field:bch3}
Is the Applicant an endorser, guarantor or co-maker for obligations not listed on its financial statements?	{field:bch4}
Are any assets of the Applicant current held in trust?	{field:bch5}
Are any assets of the Applicant pledged as collateral for other credit obligations?	{field:bch6}
Is the Applicant or any Principal, Director or Executive Officer an Executive Officer, Director or Principal Owner of a Financial Institution?	{field:bch7}
Additional Information	{field:bch_additional_information}

BANK/CREDIT INFORMATION
Primary Bank	{field:ci_primary_bank}
Average Deposit Balance	{field:ci_average_deposit_balance}
Credit Outstanding	{field:ci_credit_outstanding1}
Monthly Payment	{field:ci_monthly_payment1}
Are any Loans Past Due?	{field:ci_are_any_loans_past_due1}
Point of Contact	{field:ci_point_of_contact1}
Phone	{field:ci_phone1}
Other Creditor	{field:ci_other_creditor1}
Credit Outstanding	{field:ci_credit_outstanding2}
Monthly Payment	{field:ci_monthly_payment2}
Are any Loans Past Due?	{field:ci_are_any_loans_past_due2}
Point of Contact	{field:ci_point_of_contact2}
Phone	{field:ci_phone2}
Other Creditor	{field:ci_other_creditor2}
Credit Outstanding	{field:ci_credit_outstanding3}
Monthly Payment	{field:ci_monthly_payment3}
Are any Loans Past Due?	{field:ci_are_any_loans_past_due3}
Point of Contact	{field:ci_point_of_contact3}
Phone	{field:ci_phone3}

CREDIT REQUEST
Loan Type	{field:cr_loan_type1}
Amount Requested	{field:cr_amount_requested1}
Term	{field:cr_term1}
Amortization	{field:cr_amortization1}
Loan Purpose	{field:cr_loan_purpose1}
Collateral	{field:cr_collateral1}
Will other Collateral be pledged for the Credit Request?	{field:cr_will_other_collateral1}
List Other Collateral	{field:cr_list_other_collateral1}
Loan Type	{field:cr_loan_type2}
Amount Requested	{field:cr_amount_requested2}
Term	{field:cr_term2}
Amortization	{field:cr_amortization2}
Loan Purpose	{field:cr_loan_purpose2}
Collateral	{field:cr_collateral2}
Will other Collateral be pledged for the Credit Request?	{field:cr_will_other_collateral2}
List Other Collateral	{field:cr_list_other_collateral2}

COLLATERAL INFORMATION
For Real Estate Credit Requests. For Purchases, please attach the Purchase and Sale Agreement.
Type of Real Estate	{field:coli_type_of_real_estate1}
Purchase Price or Current Value	{field:coli_purchase_price_or_current_value1}
Source of Downpayment	{field:coli_source_of_downpayment1}
Downpayment Amount	{field:coli_downpayment_amount1}
Will the Applicant, or an affliate of the Applicant, occupy 51% or more of the Real Estate?	{field:coli_will_the_applicant1}
For Business or Investment Related Credit Requests.
Type of Collateral	{field:coli_type_of_collateral}
Purchase Price or Current Value	{field:coli_purchase_price_or_current_value2}
Source of Downpayment	{field:coli_source_of_downpayment2}
Downpayment Amount	{field:coli_downpayment_amount2}
Seller Name	{field:coli_seller_name2}
Seller Contact Information	{field:coli_seller_contact_information2}
Please print additional pages, if necessary. For Purchases, please attach the Invoice or Purchase Order.

IMPORTANT NOTICES TO APPLICANT REGARDING CREDIT REQUESTS

Collection of Demographic Information

Jamestown S’Klallam Tribal Capital shall compile such data on the gender, race, ethnicity, national origin, or other information on individuals that utilize its products and services as the CDFI Fund shall prescribe in an Assistance Agreement. Such data will be used to determine whether residents of Investment Area(s) or members of Targeted Population(s) are adequately served and to evaluate the impact of the CDFI Program.

COMMITMENT TO LEND
If the Applicant submits a Credit Application to Jamestown S’Klallam Tribal Capital, Incorporated, then the Applicant may be notified in the form of a written commitment letter if the credit request was approved. The commitment letter will state the terms and conditions under which Jamestown S’Klallam Tribal Capital will lend money or extend credit to the Applicant. The Applicant may rely upon the written commitment letter, duly signed by an Officer of JST Capital, as an agreement to receive a loan or an extension of credit from Jamestown S’Klallam Tribal Capital.
APPLICANT’S STATEMENT AND AUTHORIZATION
The questions within this Business Credit Application have been fully and truthfully answered by the Applicant. The Applicant understands that Jamestown S’Klallam Tribal Capital may check the credit records and statements made on behalf of the Applicant or Principals of the Applicant. The Applicant authorizes and directs creditors to give JST Capital any information it requests that will assist JST Capital in its assessment upon whether to grant credit to the Applicant. The Applicant gives JST Capital permission to give credit reporting agencies and other creditors information relating to any credit accomodation JST Capital might grant the Applicant. If there is more than one individual signing on behalf of the Applicant, this statement and authorization will apply to each individually and collectively. The Applicant hereby certifies the Busness Credit Application and any financial or non-financial informaton provided as part of the Business Credit Application is accurate. JST Capital may rely upon all information provided as part of the Business Credit Application in making its credit decision.
Applicant Name	{field:applicant_name}
Signatures of the duly authorized management, executive officers or board members of the Applicant:
Authorized Signer for Applicant
Print Name and Title
Date

Authorized Signer for Applicant
Print Name and Title
Date

Authorized Signer for Applicant
Print Name and Title
Date

Authorized Signer for Applicant
Print Name and Title
Date

Small Business Credit Application

Company