Loan Application

BrokerLine™ Loan Application

Name of Borrower:

Federal Tax ID Number:

Street:

City:

State:

Zip:

Phone Number:

Fax Number:

Name of Guarantor(s):

Social Security Number(s):

Street:

City:

State:

Zip:

Size of Line of Credit Requested:

Borrower's Net Worth:

Guarantor(s) Net Worth:

Yes	No	Have any Federal tax liens ever been filed against the Borrower or any of the Guarantors? (If yes, please attach an explanation.)
Yes	No	Are there any outstanding judgements against the Borrower or any of the Guarantors? (If yes, please attach an explanation.)
Yes	No	Has the Borrower or any of the Guarantors been declared bankruptcy within the past 7 years? (If yes, please attach an explanation.)
Yes	No	Is the Borrower or any of the Guarantors currently a party to a lawsuit? (If yes, please attach an explanation.)
Yes	No	Is the Borrower or is any of the Guarantors presently delinquent or in default on any debt, loan, mortgage, financial obligation, bond or loan guaranty?(If yes, please attach an explanation.)
Yes	No	Is the Borrower or is any of the Guarantors a co-maker, endorser, or guarantor on any other note? (If yes, please attach an explanation.)

Please include the following attachments with your application:

STATEMENT OF EXPERIENCE: Attach a description of the Borrower's business experience and the Borrower's proposed use of the line of credit.
FINANCIAL STATEMENTS: Please attach a copy of a detailed current financial statement for both the Borrower Guarantor(s).
TAX RETURNS: Attach a copy of the last two years' tax returns for the Borrower and Guarantor(s).
ORGANIZATIONAL PAPERS: Attach, when applicable, Article of incorporation, Certificate of Good Standing, Partnership Papers, Operating Agreement, or other papers to document the structure of the borrower.
PROFESSIONAL REFERENCES: Attach a list of at least three professional references with names, titles, addresses, daytime telephone numbers and fax numbers. Appropriate references include your bank, attorney, title company, note investors, etc.

We, the undersigned Borrower and Guarantor(s), hereby authorize First National Acceptance Company of North America (FNAC-NA) to obtain credit reports and background searches from the reporting services of its choosing. We hereby affirm that our answers to the foregoing questions are true and correct. We understand that misrepresentation of omission of fact will provide sufficient cause for rejection of this application for a line of credit. We authorize the investigation of all information we have provided. We also authorize third parties to furnish information relevant to this application.

_______________________________/___/___	_______________________________/___/___
Borrower	Guarantor
	_______________________________/___/___
	Guarantor

First National Acceptance Company of North America

241 East Saginaw Highway, Suite 200

P.O. Box 4549

East Lansing, MI 48823

toll free: 888-363-FUND

facsimile: 517-333-0390

email: fnacna@tcimet.net

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