CAPITAL
COFFMAN CAPITAL INC.
Business Credit & Finance
PRACTICE REFINANCE LOAN CHECKLIST
The following information is necessary for initial credit approval and commitment letter. Other items
will be requested in order to secure final loan commitment and closing.
BUSINESS INFORMATION
1. Coffman Capital Credit Application (please indicate whether incorporated or sole proprietor),
signed by borrower and any guarantors (any who own 20% or greater)
2. Executive Summary including history of practice and reason for refinance
3. Business Debt Schedule – indicating all business obligations and which are to be paid off
4. Copy of Note(s) to be paid off and loan payoff amounts for projected closing date
5. Business tax returns, all schedules, for last 3 fiscal years. If a sole proprietorship, personal returns
are sufficient.
6. Year to Date Income Statement and Balance Sheet no older than 60 days
7. Equipment list, detailed, including total estimated market value
8. Current Accounts Receivable Aging Summary
9. Written estimate of revenue sources by percentage (Office Pay, Insurance, Medicare, etc.)
10. Signed 4506 tax form (please do not complete, just sign and date where indicated)
PERSONAL INFORMATION
11. Credit Authorization signed by borrower and any guarantors
12. SBA Personal Financial Statement (413 form)
13. SBA Statement of Personal History (912 form)
14. Personal Income and Expenses – include other income sources such as spousal income,
investments etc and obligations that will not appear on credit report such as child support etc.
15. Resume or Curriculum Vitae
16. Color Copy of Current Doctor’s License for state practice is located
17. Color Copy of Driver’s License – Required by Patriot Act for all loan applications
18. Personal Tax Returns for 3 years for principals (20% + owners) and guarantors
19. Business Tax Returns for three years on any affiliate businesses (owned 20% + by borrower)
REAL ESTATE INFORMATION (only if real estate is involved):
20. Real estate