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~ ~ ~ <br />~'~ List your three largest customers/clients: <br />Name Contact Person Phone <br /> <br />List three major suppliers or credit references: <br />Name Contact Person Phone <br />• <br />List the name of the Lending Institution that will finance the Redevelopment project. <br />Name of Bank Contact Person Phone <br />• •- • <br />Is the business involved in any claim or lawsuit? Yes ® No ^ <br />Are there any other taxes not currently paid or in dispute? Yes ^ No <br />Has the business ever been suspended or debarred, declared <br />bankruptcy, commenced a proceeding under any bankruptcy law Yes ^ No <br />or had a judgment rendered against it? <br />Is any collateral currently pledged to other creditors? Yes ^ No <br />Is the business liable for any amount via guaranties, or Yes ® No ^ <br />commitments, or other contingency agreements? <br />If you answered "Yes" to any questions(s), please explain. Attach additional pages as <br />necessary. <br />Please make sure you attach the applicable documents listed on the Checklist for Application <br />Submittal. <br />The undersigned hereby certifies that all information provided to the City of South Bend ("South <br />Bend") herein and furnished with this application is and will be true, accurate, complete, and fairly <br />presents the financial condition of the undersigned. South Bend may check credit and trade <br />references in reviewing this application and disclose information about its credit experience with the <br />applicant, as authorized by law. South Bend may also check the personal credit history of the <br />principal owner(s) and/or key individuals. By signing below, the undersigned agree that the business <br />loan will be for the purpose identified in the loan application and in accordance with the South Bend <br />Cleanup Revolving Loan Fund requirements. <br />AUTHORIZED SIGNATURE TITLE DATE <br />City of South Bend Page 4 of 3 Final Application <br />