Crown Valley Group

Commercial Loan Application

I. PRINCIPAL'S INFORMATION

Principal's Name

Company

Social Security Number

Date Of Birth

Street Address

City

State

Zip

Mobile Tel No

Office Tel No

Home Tel No

II. Broker Information

Broker's Name

Company

Street Address

City

State

Zip

Mobile Tel No

Office Tel No

Fax

III. Loan Information

Loan Amount

Purpose of Loan

Description of Collateral

As-Is Market Value

As-Is Disposition Value (90-120 Day Sale)

As-Improved Market Value (Construction Loans Only)

Existing Debt

Plan for Repayment

IV. MISCELLANEOUS

How did you hear about us?

Are you currently working a Crown Valley representative? Yes No

If yes, please state the name of the representative

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 in every detail and accurately represents the financial condition of the Applicant(s) on the date given below. Creditor is authorized to make all inquiries it determines necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the Applicant(s). Applicant(s) will promptly notify Creditor of any subsequent changes which would affect the accuracy of this Statement. Creditor is further authorized to answer any questions about Creditor’s credit experience with Applicant(s). Applicant(s) are aware that any knowing or willful false statement 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.

By checking the box, applicant declares that he/she has read and understands the statement above.