BCS_Loan_Request_Form

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					                                                                                                       FOR A MORE PROMPT RESPONSE, PLEASE CLICK ON THE PROVIDED LINK.
         Business Credit Solutions Request Form                                                        REQUESTS SUBMITTED ON-LINE WILL ROUTE DIRECTLY TO YOUR ASSIGNED
                                                                                                       BCS RISK MANAGER.    ON-LINE BCS CREDIT APPLICATION LINK

THIS FORM IS FOR INTERNAL WACHOVIA USE ONLY. PLEASE WRITE LEGIBLY USING BLACK INK. FOR ANY FIELD WITH A $0 VALUE, PLEASE WRITE “NONE.”

 CREDIT REQUEST                   Amount Requested                                                            Purpose                                                       Term / Amortization
  Line of Credit              $_________________               ________________________________________________________________                                           ________/_________
  Letter of Credit            $_________________               ________________________________________________________________                                            ________/_________
  Term Loan                   $_________________               ________________________________________________________________                                           ________/_________
 Collateral Description (Acct # if CD/Brokerage):________________________________________________________________________________________
 Owner(s) of Collateral:_________________________________________________________________________________ Prior Liens:  Yes                                                                    No
 Collateral Address:______________________________________________________________________________ City: _________________________
 County:____________________ State:_______ Zip:_______________ Purchase Price (If New) $______________ Market Value (If Refi) $ _____________
 Auto Debit (Payment):  Yes                No                 Routing #______________________________ Account #______________________________________


 COMPANY INFORMATION (An extra copy is necessary for each company guarantor)
  Primary Borrower                Borrower            Guarantor
  C-Corp             Sub-S Corp              LLC           General Partnership                  Sole Proprietorship            Other: ___________________________________
 Legally Registered Company Name:________________________________________________ Trade or DBA Name: ____________________________
 Federal Tax ID: _________________________________________  Tax ID Missing (Why):_________________________________________________
 Physical Address (No PO Box):_______________________________________________ City:____________________ State:_______ Zip:____________
 Mailing Address (If Different):_________________________________________________ City:____________________ State:_______ Zip:____________
 Nature of Business:_______________________________________________________ State Established:_______ Date Established:________/_______
 Primary Contact:_________________________ Business Phone: (_____)______________ Primary Bank:  Wachovia                                                        Other:___________________

 (The Data in this box is only required for requests less than or equal to $100,000)

 Gross Annual Sales $______________________________                               12-Month Avg. Business Checking Balance (Non WB) $______________________________


 OWNER / GUARANTOR INFORMATION (Required for each individual with 25% or more ownership of company) An extra copy is necessary, if more than two guarantors
  Primary Borrower             Borrower           Guarantor          Hypothecator                   Borrower          Guarantor          Hypothecator
 Name:_______________________________________________________                                          Name:_______________________________________________________
 Social Security Number:_________________________________________                                      Social Security Number:_________________________________________
 Ownership %:_____________________ Owner Since:________/________                                       Ownership %:_____________________ Owner Since:________/________
 Home Address: _______________________________________________                                         Home Address: _______________________________________________
 City:__________________________ State:_______ Zip:_______________                                     City:__________________________ State:_______ Zip:_______________
 Home Phone: (_____)_______________ Date of Birth:________/________                                    Home Phone: (_____)_______________ Date of Birth:________/________
 Primary Bank:  Wachovia                 Other:______________________________                         Primary Bank:  Wachovia                Other: _____________________________
 Monthly Mortgage/Rent (Personal residence) $_________________________                                 Monthly Mortgage/Rent (Personal residence) $_________________________
 Reg. B intent to apply form completed (for co-borrower only)  Yes                        No         Reg. B intent to apply form completed (for co-borrower only)  Yes                       No

 (The Data in this box is only required for requests less than or equal to $100,000)                   (The Data in this box is only required for requests less than or equal to $100,000)

 Total Liquid Accts $_______________ Retirement Accts $______________                                  Total Liquid Accts $_______________ Retirement Accts $______________
 12 Month Avg. Checking Balance (Non WB) $ _________________________                                   12-Month Avg. Checking Balance (Non WB) $_________________________
 Adj. Annual Gross Income $_____________ Net Worth $_______________                                    Adj. Annual Gross Income $_____________ Net Worth $_______________
 (From Tax Return)                                         (Excluding Business Value)                  (From Tax Return)                                        (Excluding Business Value)


 SALES PARTNER INFORMATION
 Selling Officer Name:______________________________ Selling Officer ID:____________________ Selling Officer Segment: _____________________
 Selling Officer Co Sub / RC:_________________________ Application Received:_____/_____/_____ Customer Requested Response:_____/_____/____
 Referring Officer Name:____________________________ Referring Officer ID:__________________ Referring Officer Segment: ___________________

This facsimile message contains legally privileged and confidential information intended only for the use of the individual or entity named above. If you are not the intended recipient or responsible
for delivering to the intended recipient, you are hereby notified that any use, dissemination, distribution or copying of this telecopy or the information contained herein is strictly prohibited. If you
received this telecopy in error, please destroy all copies of the message, whether in electronic or hard copy format, as well as attachments and immediately contact the sender. Thank you!

558950 (Rev. 00)                                                                     Page 1 of 3                                                                                      BCSCRForm.doc
 HIGH RISK & MONEY SERVICE BUSINESS (Each of the following questions must be completed)
                             Does the borrower or co-borrower engage in money transmission activities as a principal or as an agent of a Money Service
      Yes          No      Business (MSB)? That is, do they engage as a business in the transfer of funds through a financial institution or an "informal value
                             transfer system?"

      Yes          No      Does the borrower or co-borrower engage in currency exchange activities? That is, do they engage in the physical exchange of
                             currency for retail customers?

      Yes          No      Does the borrower or co-borrower cash checks in an amount greater than $1000 for any person on any one day in one or more
                             transactions?

      Yes          No      Does the borrower or co-borrower issue, sell or redeem traveler’s checks, money orders, or stored value cards in an amount
                             greater than $1000 for any person on any one day in one or more transactions?

 Select all that apply       Does the borrower or co-borrower engage in any of the following high-risk activities?

  Casino                                                                                        Offshore bearer share company (where Wachovia controls shares)
  Charity or Foundation (except widely recognized entities like Red Cross)                      Offshore Non-operating Company (PIC)
  Travel Agency (except publicly traded or widely recognized)                                   Payable-Through Account
  Foreign Financial Institution                                                                 Senior Foreign Political Figures and Family (PEPSs)
  Non-US Embassy or Consulate                                                                   Not Applicable
  Non-US Private Banking Customers


 MINIMUM INFORMATION REQUIREMENTS                                                                 $0-$100M *               $100M-$500M                        $500M+

 BCS Request Form                                                                                      Yes * *                    Yes * *                           Yes * *

 Personal Financial Statement                                                                          N/A                        Yes                               Yes

 Personal Tax Returns                                                                                  N/A                        2yrs                              3yrs

 Reviewed / Audited Financials or Business Tax Returns                                                 N/A                        2yrs                              3yrs

 Account Receivable Aging                                                                              N/A                        Yes * * *                         Yes * * *

 Business Debt Schedule                                                                                No                         Yes * * * *                       Yes * * * *
 *     If 2 scored requests have already been submitted in the past 12 months, or a non profit request, utilize next category $100-$500M information requirements
 **     Letter of Credit Application is required for all Letter of Credit Requests (in addition to the BCS Request Form)
 ***     Account Receivable Aging(s) required for Lines of Credit >$250,000 not secured with Preferred Collateral
 ****      Investment Real Estate Requests will require additional financial disclosure(s) (rent rolls, leases, etc.)


 REQUEST SUBMISSION                          Interoffice                    Fax                      Address                    Segment                        Region
                                                                                                                            Wealth / Private          ALL
                                                                                              8740 Research Drive           Advisory Group
                                               NC1120
          Charlotte BCS                                              1-877-326-4071           2nd Floor                     Retail / Small            NC, SC, GA, FL, TX, AL,
                                          Preferred Method
                                                                                              Charlotte, NC 28262           Business Banking          MS, TN
                                                                                                                            Business Banking          GA, FL, TX, AL, MS, TN
                                                                                              One West Fourth Street
                                               NC6977
       Winston-Salem BCS                                             1-877-326-4072           3rd Floor                     Community                 ALL
                                          Preferred Method
                                                                                              Winston-Salem, NC 27101

                                                                                                                            BRB                       ALL
                                                                                              123 S. Broad Street
                                               PA1322                                                                       Retail / Small            VA, MD, DC, PA, DE,
        Philadelphia BCS                                             1-877-325-3175           Witherspoon 10th              Business Banking          NY, NJ, CT
                                          Preferred Method
                                                                                              Philadelphia, PA 19109                                  NC, SC, VA, MD, DC,
                                                                                                                            Business Banking
                                                                                                                                                      PA, DE, NY, NJ, CT
Additional Comments / Notes (Optional):______________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Notable Changes on Financial Statements (Optional): ___________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Customer Hot Points / Critical Issues (Optional):________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________


558950 (Rev. 00)                                                                Page 2 of 3                                                                          BCSCRForm.doc
Both pages of this Business Credit Solutions Request Form are required. Forms submitted without page two completed will be considered an incomplete application. Incomplete applications will be
returned to the Sales Partner listed on page one of the Request Form. Thank you for your request submission. BCS is dedicated to providing exceptional customer service to you and your
customers.




558950 (Rev. 00)                                                                 Page 3 of 3                                                                                 BCSCRForm.doc

				
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