Primary Account Holder
	*First Name
	*Last Name
	*Address

	*Own or rent?	Own Rent Years
	*City
	*State
	*Zip
	Social Security #
	*Phone
	Date of Birth
	Employer
	*Self Employed?	Yes No
	Title
	Business Address
	Business Phone
	Type of Business
	Years on this job
	Years in profession
	E-mail

Secondary Account Holder
	First Name
	Last Name
	Address

	Own or rent?	Own Rent Years
	City
	State
	Zip
	Social Security #
	Phone
	Date of Birth
	Employer
	Self Employed?	Yes No
	Title
	Business Address
	Business Phone
	Type of Business
	Years on this job
	Years in profession

	Accountant:	Name Telephone Fax
	Attorney:	Name Telephone Fax

Business Borrower

Legal Name

Address

City

State

Zip

Nature of Business

Telephone

Date Established

SSN or TIN

Number of Employees

Annual Gross Revenue

Organizational Structure

Mortgage Loan Request

     Loan Amount

     Purchase Price

Down Payment

Purchase Date

If Refinance:

Current Value

Current Loan Balance

Bank Holding Mortgage

Account Number

     Purpose of Loan

     Loan Term

     Property Address

     Property Type     Number of Units



Income

Unit# Tenant Monthly Rent Annual Rent

Total

Expenses

RE Taxes

Insurance

Utilities

Water/Sewer

Management

Maintenance

Total

     Lead Paint Yes No Delead Certificate

Underground Storage Tank Yes No

Renovations Planned

Renovations Cost

Business Loan Request
	Loan Type Loan Amount Term
	Colateral Colateral Value
	Purpose of Loan

List All Bank Accounts and Loans
	Bank Name	Type (Dep/Loan)	Balance	Account#	Date Opened

Three Largest Suppliers
	Suppliers Name	Address	High Balance	Telephone#	Contact Person

	Have you, any officer of your company, or any guarantor been involved in bankruptcy?	Yes No
	Are you personally or is your business involved in any lawsuits or pending litigation?	Yes No
	Are all of your personal and business' tax obligations current?	Yes No
	Are you or your company currently a customer of East Boston Savings Bank?	Yes No
	Account Numbers