UPBACDA MD LOAN APPLICATION FORM

 

NAME OF APPLICANT: ____________________________________________________________________

 

 

DATE OF APPLICATION: _____________________________________________

 

 

AMOUNT APPLIED FOR: _____________________________________

 

 

SURETY / SURETIES: _______________________________       ____________________________________

 

                                         _______________________________   ___________________________________

                                                   SIGNATURE                                                   SIGNATURE

 

 

EXPECTED PAY BACK DATE: _____________________________________

 

 

INTEREST RATE 5%: __________________________________________

 

 

DECLINED _________                    APPROVED ______________

 

 

DATE: ________________________________________

 

 

   __________________________________   _________________          ___________________________     ________________

    SIGNATURE OF PRESIDENT                           DATE                      SIGNATURE OF APPLICANT              DATE