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Community Emergency Loan Application
Submitter Information (Required)
First Name (required)
Last Name (required)
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COMMUNITY EMERGENCY LOAN FUND

On March 20th, 2020 Oregon Pacific Bank committed to lend up to $5,000,000 to businesses and non-profits that reside in the communities of Coos Bay, Eugene, Florence, Medford, and Roseburg. The funds are to be used in our community and to reduce the impact of COVID-19 for our current clients and prospective clients.

Oregon Pacific Bank will underwrite the application for financing based on the information provided by the applicant and the Bank’s predetermined underwriting criteria. Part of the underwriting will include the Bank’s best assessment of the borrower’s long term viability. Oregon Pacific Bank will not violate any fair lending laws, but reserves the right to deny any applicant that may be deemed unable to repay the full principal and interest over the contractual terms.

APPLICANT / BUSINESS INFORMATION
Business NameDate Business Established
(required) (required)
Are you an existing client? (required)
Street Address (required)
Business Phone # (required)
Type of entity?
Select entity type
S-Corp
 
C-Corp
 
LLC
 
Other
 
If other, please explain
Do you own the building? (required)
If no, monthly rent payment?
Have you contacted your landlord or lien holder for payment relief? (required)
If yes, was a concession made?
Have you contacted other creditors for payment relief? (required)
If yes, was a concession made?
If any concessions have been made, please describe:
Have you had to close or reduce the hours of the business? (required)
If yes, please explain below:
Please provide the following year end 2019 financial information
Amount $
Gross Revenue/Sales (required)
Total Expenses (including depreciation/amortization expense) (required)
Total Interest Expense (required)
Total Depreciation and Amortization Expense (required)
Net Income (required)
Please fill out the business debt schedule below:
LenderLoan TypeBalanceMonthly PaymentMaturity Date
1.
 

 

 

 

 
2.
 

 

 

 

 
3.
 

 

 

 

 
4.
 

 

 

 

 
5.
 

 

 

 

 
LOAN REQUEST
Amount (required)
How are you applying for this loan? (required)
If jointly, please list who
Use of Loan Proceeds:
$ Amount
Ongoing Operations
 
Rent
 
Loan Payments
 
Payroll
 
DescriptionAmount $
Other
 

 
Other
 

 
Other
 

 
How many months of operations will the loan funds sustain your business? (required)
OWNER / PERSONAL INFORMATION
NameSocial Security Number

 

 
Street Address
Home Phone #Cell Phone #Email Address

 

 

 
ASSETS
Amount $
Cash on Hand and In Banks (required)
Savings Account (required)
IRA/Other Retirement Accounts (required)
Accounts/Notes Receivables (required)
Cash Value of Life Insurance (required)
Stocks and Bonds (required)
Personal Residence (required)
Other Real Estate (Total) (required)
Automobiles (required)
Other Personal Property (required)
Total Assets (required)
LIABILITIES
Amount $
Credit Card(s) Payable (required)
Auto Loan(s) (required)
Loan(s) Against Life Insurance (required)
Personal Mortgage (required)
Other Real Estate Loans (required)
Other Installment Loans (required)
Unpaid Taxes (required)
Total Liabilities
 
Total Net Worth (required)
APPLICANT'S CONSENT

In order to help the lender understand more about the financial condition of the business, please submit the following items in conjunction with this application to help us get started. (Additional information may be required at a later time.)

Entity Formation Documents e.g. Operating Agreement, Corporate Bylaws (required)

FINANCIAL CONDITION. The applicant(s) and guarantor(s) have provided the lender with information on their financial condition(s). By signing this credit application, applicant(s) and any guarantor(s) signing below warrant to lender that the information provided above is true and correct and that there has been no adverse change in their financial condition(s) as disclosed to lender on their most recent financial statement(s). Lender is authorized to make any investigation of the credit and employment status of applicant(s) and guarantor(s) either directly or through any agency employed by lender.

SIGNATURE(S)
Applicants Signature
Typed name is accepted for online application
Applicant SignatureDateApplicants Printed Name/Title
(required) (required) (required)
Co-applicants Signature
Typed name is accepted for online application
Co-Applicant's/Guarantor's SignatureDateCo-Applicants/Guarantor's Printed Name/Title
(required) (required) (required)
ADDITIONAL OWNER/PERSONAL INFORMATION (If Applicable)
NameSocial Security #

 

 
Street Address
Home Phone #Cell Phone #Email Address

 

 

 
ASSETS
Amount $
Cash on Hand & In Banks
 
Savings Account
 
IRA/Other Retirement Accounts
 
Accounts/Notes Receivables
 
Cash Value of Life Insurance
 
Stocks and Bonds
 
Personal Residence
 
Other Real Estate (Total)
 
Automobiles
 
Other Personal Property
 
Total Assets
 
LIABILITIES
Amount $
Credit Card(s) Payable
 
Auto Loan(s)
 
Loan(s) Against Life Insurance
 
Personal Mortgage
 
Other Real Estate Loans
 
Other Installment Loans
 
Unpaid Taxes
 
Total Liabilities
 
Total Net Worth
APPLICANT'S CONSENT

FINANCIAL CONDITION. The applicant(s) and guarantor(s) have provided the lender with information on their financial condition(s). By signing this credit application, applicant(s) and any guarantor(s) signing below warrant to lender that the information provided above is true and correct and that there has been no adverse change in their financial condition(s) as disclosed to lender on their most recent financial statement(s). Lender is authorized to make any investigation of the credit and employment status of applicant(s) and guarantor(s) either directly or through any agency employed by lender.

SIGNATURE
Applicants SignatureDateApplicants Printed Name/Title

 

 

 
ADDITIONAL OWNER/PERSONAL INFORMATION (If Applicable)
NameSocial Security #

 

 
Street Address
Home Phone #Cell Phone #Email Address

 

 

 
ASSETS
Amount $
Cash on Hand & In Banks
 
Savings Account
 
IRA/Other Retirement Accounts
 
Accounts/Notes Receivables
 
Cash Value of Life Insurance
 
Stocks and Bonds
 
Personal Residence
 
Other Real Estate (Total)
 
Automobiles
 
Other Personal Property
 
Total Assets
 
LIABILITIES
Amount $
Credit Card(s) Payable
 
Auto Loan(s)
 
Loan(s) Against Life Insurance
 
Personal Mortgage
 
Other Real Estate Loans
 
Other Installment Loans
 
Unpaid Taxes
 
Total Liabilities
 
Total Net Worth
APPLICANT'S CONSENT

FINANCIAL CONDITION. The applicant(s) and guarantor(s) have provided the lender with information on their financial condition(s). By signing this credit application, applicant(s) and any guarantor(s) signing below warrant to lender that the information provided above is true and correct and that there has been no adverse change in their financial condition(s) as disclosed to lender on their most recent financial statement(s). Lender is authorized to make any investigation of the credit and employment status of applicant(s) and guarantor(s) either directly or through any agency employed by lender.

SIGNATURE
SIGNATURE
Applicants SignatureDateApplicants Printed Name/Title

 

 

 
ADDITIONAL OWNER/PERSONAL INFORMATION (If Applicable)
NameSocial Security #

 

 
Street Address
Home Phone #Cell Phone #Email Address

 

 

 
ASSETS
Amount $
Cash on Hand & In Banks
 
Savings Account
 
IRA/Other Retirement Accounts
 
Accounts/Notes Receivables
 
Cash Value of Life Insurance
 
Stocks and Bonds
 
Personal Residence
 
Other Real Estate (Total)
 
Automobiles
 
Other Personal Property
 
Total Assets
 
LIABILITIES
Amount $
Credit Card(s) Payable
 
Auto Loan(s)
 
Loan(s) Against Life Insurance
 
Personal Mortgage
 
Other Real Estate Loans
 
Other Installment Loans
 
Unpaid Taxes
 
Total Liabilities
 
Total Net Worth
APPLICANT'S CONSENT

FINANCIAL CONDITION. The applicant(s) and guarantor(s) have provided the lender with information on their financial condition(s). By signing this credit application, applicant(s) and any guarantor(s) signing below warrant to lender that the information provided above is true and correct and that there has been no adverse change in their financial condition(s) as disclosed to lender on their most recent financial statement(s). Lender is authorized to make any investigation of the credit and employment status of applicant(s) and guarantor(s) either directly or through any agency employed by lender.

SIGNATURE
Applicants SignatureDateApplicants Printed Name/Title