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29 <br />Confidential <br />Business Financial Information <br />Who is your primary bank? <br />Insurance Provider? <br />Accounting firm? <br />Attorney? <br />Approximate balance in your business checking account? <br />Payment <br />Frequency <br />Interest <br />Rate <br />Maturity <br />Date <br />Approximate balance in other checking accounts <br />Approximate balance in your savings account <br />Please list all business debt and corresponding payment information: <br />Creditor <br />Account <br />Balance <br />Payment <br />Amount <br />Payment <br />Frequency <br />Interest <br />Rate <br />Maturity <br />Date <br />I <br />Collateral <br />Is the business or any principal /owner an endorser, guarantor, or co -maker for obligation(s) not listed <br />above? <br />Is the business or any principal /owner a party to any threatened or pending claim or lawsuit? <br />Are there any delinquent FICA or sales taxes? <br />Has the business or any principal /owner ever declared bankruptcy? <br />:1 Yes ❑ No <br />Yes ❑ No <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Please attach ex lanation for any questions answered "Yes" <br />The signer(s) certifies that he /she is authorized to execute the application for the business named above, and that the <br />information in this application and any other documents submitted in connection with the application is complete, true, <br />and correct. The signer(s) authorizes the Orange County Small Business Loan Pool to verify the information and to obtain <br />personal, consumer and /or business credit reports. The signer(s) further agrees to provide additional information upon <br />request and to notify the OCSBLP promptly of any material change in the information provided in tlus application <br />Business Name Date Additional Guarantor Signature Date <br />Page 3 of 4 <br />