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					                                                                    Member FDIC

 800 758-1741 * Toll Free Fax 866 358-6018 * 133 Main Street * PO Box 98 * Hulett, WY 82720
                                    www.summitnb.com



Commercial Loan Applicant:

Due to the Patriot Act and our bank policies, we are required to collect certain
information from you in order to consider your loan.

In addition to the loan forms, we will need the following:

         Proof of Income: Include copies of your last three (3) years of income tax
         returns.

         Proof of Physical Address: Include a copy of a form that has your physical
         address on it (i.e. electric bill).

         Proof of Tax Identification: Include a copy of your Social Security Card.

         Proof of Identification by Government issued Picture ID: Include a copy
         of your Drivers License, State ID, or Military ID.

         Proof of Business Identification: If applicable, include a copy of the state
         and/or federal business registration documents.

 We will also need a detailed Business Plan that will:
                 1. Identify and explain your business goals and objectives.
                 2. Identify, describe and define your business, including the
                    products/services on which the business will be based, the target market,
                    and the business competition.
                 3. Document your financial viability. Identify costs and expenses, revenue
                    expectations, and contingency alternatives if revenues fail to meet
                    minimum requirements.
                 4. Identify your capital start-up needs and sources.

If you have any questions while preparing these documents, feel free to call us.

          Thank-you for applying for a loan with Summit National Bank.


                                                Updated: 02/02/10. b808010d-16dd-4ad3-8e0f-56ac828c16f4.xls
Commercial Loan Application                                                                                                                                                      Page 2 of 7



                                                                                                                   COMMERCIAL LOAN CREDIT APPLICATION
For the purposes of obtaining credit from time to time with the bank, the following statement and information are furnished as a complete, true, and
accurate statement of the financial condition. All amounts are rounded to the nearest $100.
                                                               Financial Statement as of:
                                                                     1. CREDIT TYPE
                          IMPORTANT: Please read these directions before completing this financial statement. Check box that applies.
       If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for
       repayment of the credit requested, only complete the applicant sections of this financial statement.
       If you are applying for joint credit with another person, complete all sections, providing information about both applicants.
       We intend to apply for joint credit (please initial)    Applicant ____________         Co-Applicant ____________
       If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as
       the basis for repayment of the credit requested, complete all sections to the extent possible, providing information in the Co-Applicant sections about the person on whose
       alimony, child support, or maintenance payments or income/assets you are relying.
        Amount Requested              For How Long Payment Date                      Want to Repay             Proceeds of Loan to be used for:
                                                                                Monthly
                                                                                Monthly            Other

Applicant                                                                      2. APPLICANT INFORMATION                                                                       Co-Applicant
Name (include Jr. or Sr. if applicable)                                                       Name (include Jr. or Sr. if applicable)


        Social Security No.               Home Phone          Date of Birth     Yrs. School          Social Security No.                Home Phone           Date of Birth    Yrs. School


     Married           Separated                 Dependents (not listed by Co-App)                 Married           Separated                 Dependents (not listed by App)
     Unmarried (Explain)               No./Age                                                     Unmarried     (Explain)          No./Age

  Address (street, city, state, zip)        Rent        Own       No. Years                    Address (street, city, state, zip)              Rent          Own No. Years



Applicant                                                                     3. EMPLOYMENT INFORMATION                                                                       Co-Applicant
            Name & Address of Employer                             Self Employed*                            Name & Address of Employer                             Self Employed*

                                                                 Yrs on Job:                                                                                    Yrs on Job:
                Yrs. In this line of work or profession:                                                          Yrs. In this line of work or profession:
           Position/Title/Type of Business                          Business Phone                         Position/Title/Type of Business                           Business Phone


                          If employed in current position for less than two years or if currently employed in more than one position, complete the following:
A - Applicant
                           Previous Employer                   City/State             Type of Business                Position/Title              Dates From/To               Monthly Income
C - CoApp



* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

                              4a. ASSETS                                                                                   4b. LIABILITIES
Cash (Schedule 1)                                                                             Short Term Notes Due Financial Institution (Schedule 6)
Security (Schedule 2)                                                                         Short Term Notes Due to Others (Schedule 6)
Life Insurance Cash Value (Schedule 3)                                                        Credit Accounts and Bills Due (Schedule 7)
Mortgages & Contracts Held by You (Schedule 4)                                                Insurance Loans (Schedule 3)
Real Estate (Schedule 5)                                                                      Mortgages on Home (Schedule 5)
Profit Sharing (Net of Loans)                                                                 Mortgages on Other Real Estate (Schedule 5)
Pension & Retirement Accts, Include IRA Accts                                                 Taxes
Automobiles (Describe)                                                                        Other Liabilities (Describe)



Personal Property
Other Assets (Describe)
Valuable items to me




                                                                                                                                                      Total Liabilities
                                                           Total Assets                         (Total Assets Less Total Liabilities)                       Net Worth




                                                                                                                                                                       Please Initial
Commercial Loan Application                                                                                                                                                 Page 3 of 7

                          5. GROSS MONTHLY INCOME                                                                              5B. DISCLOSURES
                Item                     Applicant        Co-Applicant          Total                                  Item                                Applicant      Co-Applicant
Base Empl. Income                                                                            Are you a Co-Maker, Endorser, or Guarantor of any
                                                                                             other person's debt?                                           N       Y          N    Y
Overtime
Bonuses
                                                                                             Are you a defendant in a legal suit or action?                 N       Y          N    Y
Dividends/Interest
Net Rental Income                                                                            Have you ever filed bankruptcy or had a judgment filed
                                                                                             against you?                                                   N       Y          N    Y
Other**

                                                                                             Have you made a will?                                          N       Y          N    Y

                               Total
** Alimony, child support, or separate maintenance income need not be revealed if the Applicant or Co-Applicant does not choose to have it considered as a basis for repaying this loan.

                                                                                   6. INSURANCE
Company                                                                   Agent                                                  Email
Phone                                                   Fax                                                      Address

                                                                                   7. SCHEDULES
                                                                 Schedule 1 – Cash on Hand and in Banks
      Name of Bank or Financial Institution                                                   Type of Account                                                   Account Balance




                                                                                                                                                Total
                                                                         Schedule 2 – Securities Owned

    Par Value or # of Shares                     Description                  Registered in Name(s) of                     Listed or Unlisted                Current Market Value




                                                                                                                                                Total
                                                                           Schedule 3– Life Insurance
        Insurance Company                 Insured         Beneficiary             Face Value of Policy                  Cash Value of Policy                           Loans




                                                                                                         Total

                                              Schedule 4 – Receivables Due to Me on Mortgages and Contracts I Own
           Name of Debtor                   Property Description           1st or 2nd Lien    Maturity Date                Repayment Terms                       Balance Due

                                                                                                                                  per

                                                                                                                                  per

                                                                                                                                  per

                                                                                                                                  per

                                                                                                                                  per

                                                                                                                                                 Total



                                                                                                                                                                  Please Initial
Commercial Loan Application                                                                                                                                               Page 4 of 7


                                                                       Schedule 5 – Real Estate Owned

                                                                            Mortgage
     Description of Property         Purchase Price Insured Value                            Maturity Date              Repayment Terms                    Current Market Value
                                                                            Balance

Home Mortgage (primary
                                                                                                                                per
residence)

                                                                                                                                per

                                                                                                                                per

                                                                                                                                per

                                                                                                                                per

                                                                                                                                per

                                                                                                             Total (not including primary residence)

                                                             Schedule 6 – Short Term Notes and Loans Due
         Name of Creditor                                 Collateral                         Maturity Date              Repayment Terms                         Balance Due

Financial Institution                                                                                                           per

Financial Institution                                                                                                           per

Financial Institution                                                                                                           per

Financial Institution                                                                                                           per

Other                                                                                                                           per

Other                                                                                                                           per

                                                              Financial Institution Total                                                Other Total

                                                               Schedule 7 – Credit Accounts and Bills Due
                                            Name of Company                                                             Repayment Terms                         Balance Due
                                                                                                                                per

                                                                                                                                per

                                                                                                                                per

                                                                                                                                per

                                                                                                                                per

                                                                                                                                per

                                                                                                                                                Total

                                                               8. ACKNOWLEDGEMENT AND AGREEMENT

BLANKET AUTHORIZATION I certify that everything state in this application and on any attachments is true and correct. I have made no misrepresentations in this application
or with other documents, nor did I omit any pertinent information. I have applied for the loan indicated in this application to be secured by a first mortgage or deed of trust on the
property described herein, and represent that the property will not be used for any illegal or restricted purpose. I fully understand that it is a Federal crime to knowingly make any
false statements when applying for a loan. The Lender may keep this application whether or not it is approved. I hereby give my consent for information contained in this loan
application or in other documents required in connection with the loan, either before the loan is closed or as part of its quality control program, to be verified or re-verified. This
verification/re-verification may be made by SUMMIT NATIONAL BANK, its agents, successors, and assigns either directly or through a credit reporting agency. I understand that
I must update credit information at Lender’s request if my financial condition changes.

FEDERAL CREDIT APPLICATION INSURANCE DISCLOSURE I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance
product or annuity in connection with this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING EXTENSION OF CREDIT ON EITHER: (1) My
purchase of an insurance product or annuity from you or from your affiliates; or (2) My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or
annuity from an unaffiliated entity.

By signing, I acknowledge that I have read and understand both the Blanket Authorization and the Federal Credit Application Insurance Disclosure.




Applicant’s Signature                                          Date                                           Co-Applicant’s Signature                                             Date
                                                                                    PROFIT AND LOSS STATEMENT
                                                                For:
                                                        Dated as of:
                                 DESCRIPTION                                  PRIOR YEAR      CURRENT YEAR
Business Income
   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
                                                  Total Cash Income

Operating Expenses
   1 Auto and Truck Expense
   2 Machinery Hire
   3 Freight and Trucking
   4 Fuel and Oil
   5 Insurance (other than health and life)
   6 Interest
   7 Labor
   8 Cash Rent
   9 Machinery and Equipment Repairs
  10 Supplies
  11 Real Estate Taxes
  12 Utilities ( telephone and electricity)
  13 Legal and Accounting
  14
  15
  16
                                          Total Operating Expenses

Other Expenses
   17 Family living (including health/life insurance)
   18 Principal Paid on Debts*
   19
   20
                                               Total Other Expenses

                                             NET PROFIT/LOSS**
       *Do not include operating debt
       **Do not include depreciation




       Signature                                        Date           Signature                       Date
                                                                   Member FDIC

  800 758-1741 * Toll Free Fax 866 358-6018 * 133 Main Street * PO Box 98 * Hulett, WY 82720
                                      www.summitnb.com



               Agreement to Pay Loan Processing Expenses


  By signing below, I understand there are expenses associated with processing this
 loan. I agree to pay all processing expenses even if the loan applied for is denied or
                                      withdrawn.




Applicant                      Date                 Co-applicant                    Date
                                                                   Member FDIC

  800 758-1741 * Toll Free Fax 866 358-6018 * 133 Main Street * PO Box 98 * Hulett, WY 82720
                                     www.summitnb.com

   We offer Credit Life Insurance and Disability Coverage!



Credit Life Insurance
The following products are available with your loan (single or joint):

       *   GROSS PAY LIFE – Insurance coverage equal to the total of payments
       *   NET PAY LIFE – Insurance coverage equal to the amount financed
       *   DECREASING LIFE – Coverage decreases commensurate with the payment schedule
       *   LEVEL LIFE COVERAGE – Coverage stays the same for the term of the loan




Disability
The following products are available for a single or joint loan that is setup with regular
installment payments (monthly, quarterly, etc.):

       *
           7 DAY RETRO AND 14 DAY RETRO – Full Term customer has to be off for either
           (7) or (14) days, depending on plan chosen, to file for benefits – once qualified
           coverage goes back to the first day of disability

       *   30 DAY ELIMINATION – Full Term – the first 30 days of disability are eliminated

       *   30 DAY ELIMINATION WITH 24 MONTH CRITICAL PERIOD – Same as above

       *   12 MONTH CRITICAL PERIOD – Same as above except there are only 12 benefit
           periods; loan must mature for at least 3 years before insurance can be used

       *   36 MONTH CRITICAL PERIOD – Same as above except there are 36 benefit
           periods; loan must mature for at least 5 years before insurance can be used

				
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