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Small Business Loan Application

Name:	Social Security:
Home Address:	City, State, Zip: , ,
Direct Phone #:	Email:
Ownership %:
Signer 2 Name:	Signer 2 Social Security:
Home Address:	City, State, Zip: , ,
Signer 2 Direct Phone #:	Signer 2 Email:
Signer 2 Ownership %:
Business Legal Name:	Business DBA:
Federal Tax ID:	Years in Business:
Business Address:	Business City, State, Zip: , ,
Business Type:	Business Website:
Annual Sales Last Calendar Year:	Projected Annual Revenue This Year:
Amount Requested:
Lease/Mortgage Payment:	Industry:
Use of Funds:	Have a Daily/Weekly payment loan?:
If so, what is the Lender name and outstanding balance?:	Daily/Weekly Payment Loan Balance:

Declaration

The above information, together with any accompanying financial statements, schedules, or other material is submitted for the purpose of obtaining credit and is warranted to be true, correct, and complete.

The undersigned hereby warrants that any individual identified above who is either a principal, a personal guarantor, or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, has provided his / her written authorization for inquiry into their credit worthiness, including but not limited to obtaining a consumer credit report, and he/she will hold Ameris Bank d/b/a Balboa Capital and its assigns, agents or nominees harmless from and against all claims, demands, losses and liabilities, suits and legal proceedings, and any and all related costs and expenses, including but not limited to attorney’s fees and costs, incurred as a result. The undersigned understands that such investigation may include seeking information as to the background credit and financial information of any of your officers and principals. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to enter into the binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in a good-faith exercised any right under the Consumer Credit Protection Act.

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 write to Ameris Bank d/b/a Balboa Capital Corp, 575 Anton Boulevard, 12th floor, Costa Mesa, California 92626, 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 a request for the statement.

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Balboa Capital https://www.balboacapital.com

Timestamp

Audit

January 22, 2021 4:35 am PDT

Small Business Loan Application Uploaded by Balboa Capital - marketing@balboacapital.com IP 12.232.63.141

March 16, 2021 1:15 pm PDT

Krystina J. Ortega - krystinajo@balboacapital.com added by Tanveer Hussain - tanveer.hussain@balboacapital.com as a CC'd Recipient Ip: 119.153.107.148

March 16, 2021 3:51 pm PDT

Krystina J. Ortega - krystinajo@balboacapital.com added by Tanveer Hussain - tanveer.hussain@balboacapital.com as a CC'd Recipient Ip: 119.153.107.148

April 6, 2021 2:51 pm PDT

Krystina J. Ortega - krystinajo@balboacapital.com added by Tanveer Hussain - tanveer.hussain@balboacapital.com as a CC'd Recipient Ip: 119.153.107.148

April 27, 2022 1:58 pm PDT

Krystina J. Ortega - krystinajo@balboacapital.com added by Tanveer Hussain - tanveer.hussain@balboacapital.com as a CC'd Recipient Ip: 119.153.107.148

February 22, 2023 7:49 am PDT

Krystina J. Ortega - krystinajo@balboacapital.com added by Balboa Capital - marketing@balboacapital.com as a CC'd Recipient Ip: 194.60.86.95

February 23, 2023 7:29 am PDT

Krystina J. Ortega - krystinajo@balboacapital.com added by Balboa Capital - marketing@balboacapital.com as a CC'd Recipient Ip: 194.60.86.98

April 19, 2023 1:14 pm PDT

Krystina J. Ortega - krystinajo@balboacapital.com added by Balboa Capital - marketing@balboacapital.com as a CC'd Recipient Ip: 208.87.234.202