Please complete a separate sheet for each member, partner, general partner, limited partner, shareholder, and corporate officer, owning 10% or more interest.

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* 1. Borrower Information

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* 2. We are pleased you are considering applying for a loan from Ventana Fund. Ventana Fund’s loans are available for New Mexico Businesses. “New Mexico Business" or “New Mexico Businesses" means a business with its principal office and a majority of its full- time employees located in New Mexico, including a sole proprietorship, partnership, limited partnership, limited liability company or corporation. For purposes of this loans from Ventana Fund, a nonprofit organization may qualify as a New Mexico Business and a limited liability limited partnership (LLLP) with a general partner that meets the above definition of a New Mexico Business qualifies as a New Mexico Business; provided that the LLLP expends the funds from the VF loan on projects within the Stace of New Mexico. 

In order to meet this definition:
1. The Borrower must be one of the following: Sole proprietor, Partnership, Limited partnership, Limited liability limited partnership, Limited liability company, or Corporation
2. Borrower’s Principal Office must be located in New Mexico; and
3. The majority of Borrower’s full-time employees must reside full time in New Mexico.

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Is the borrowing entity a NM Business?

PENDING LITIGATION/MUNICIPAL, LOCAL GOVERNMENT, ADMINISTRATIVE/CREDITOR ISSUES

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* 3. Has the undersigned been in default on any obligations to pay principal or interest to any creditor and/or ever had a payment(s) past due 60 days or more and/or ever requested or received a modification of the payment terms of any outstanding loan?

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* 4. Is there any pending litigation in which the undersigned is a party or which affects the borrowing entity or the property?

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* 5. Has the undersigned ever had any property repossessed and/or does the undersigned owe any taxes for the years prior to the current year?

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* 6. Are you a citizen of a country other than the United States, if yes, are you a resident alien?
US Citizens please provide photocopies of unexpired Driver's License, US Passport or other US/State Govt. issued ID.
Non-US Citizens please provide photocopies of an unexpired Passport, US Resident or Non-Resident Alien Registration Card.

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* 7. Have you ever obtained credit under any other name or have been known by any other

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* 8. Has any administrative action, notice of violation or other code enforcement action been taken, in the past five years, with respect to any property in which the undersigned has an ownership interest either directly or through business entity?

PAST LITIGATION, JUDGMENTS, CRIMINAL CHARGES

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* 9. Has there been any litigation filed by or against the undersigned in the last seven years?

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* 10. Are there any outstanding Judgments or Liens against the individual, company or partnership?

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* 11. Are there, or have there ever been, any Foreclosure Actions or Deeds in Lieu regarding any of the properties in which the undersigned has or had ownership interest.

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* 12. Has the undersigned ever been convicted of or charged with commission of fraud, embezzlement, theft, forgery, bribery, falsification or destruction of records, or making false statements?

BANKRUPTCY HISTORY

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* 13. Has the undersigned been a party to a bankruptcy or insolvency proceeding of any kind in the past ten (10) years?

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* 14. Has the undersigned ever been a party to a bankruptcy or insolvency proceeding with regard to any of the properties in which the undersigned has or had ownership interest.

DEBARMENT / SUSPENSION

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* 15. Is the undersigned presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal or state department, agency or instrumentality.

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* 16. Please attach additional information and an explanation for any YES answer above.

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* 17. I hereby certify that the statements made above and the additional information attached are true and correct.

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