* required field
Applicant Information
* Legal Name of Company:
* Street Address:
* City:
* State:
County:
* Zip Code:
* Telephone No.:
Facsimile No.:
* Contact Person:
Title:
* Type of Business:
Number of Employees:
Years in Business Under Current Ownership:
Corporation
Partnership
Proprietorship
LLC
Other (specify)
* Taxpayer ID Number:
State of Organization:
Annual Sales:
Annual Net Profit:
Company Bank Reference
(Please provide copies of your most recent bank statements when meeting with a Bank of the Ozarks loan officer.)
Current Bank of the Ozarks' customer? Yes No
* Bank Name:
Deposit Acct. No.:
* Phone:
* Contact:
Balance:
Bank Name:
Loan Acct. No.:
Phone:
Contact:
Balance:
Company Trade Reference
Creditor Name:
Acct. No.:
Phone:
Contact:
Balance:
Equipment
* Equipment Description
(Year, Make, Model/Serial #):

* Cost:
Supplier/Vendor:
Contact:
Telephone Number:
Owner Personal Information
Name:
Home Street Address:
City:
State:
Zip Code:
Years at Current Address:
Home Phone No.:
Date of Birth:
Percentage Ownership of Applicant:
Gross Annual Income:
Net Worth:
Acknowledgment

By clicking submit, the applicant and owners submit the above information for the purpose of obtaining credit and represents that all such information is true, complete and accurate. The applicant and owners authorize Bank of the Ozarks and its affiliates, successors, and assigns (collectively, "Bank") to obtain consumer credit reports relating to their individual credit history and/or creditworthiness in connection with: (a) this credit application by the applicant identified above ("Applicant"); (b) any guaranty by the undersigned of the debts, liabilities or obligations of Applicant to Bank; (c) Bank's periodic review of any credit extended by Bank to Applicant, or any guarantee of thereof by the undersigned; (d) any collection action with respect to any credit extended by Bank to Applicant, or any guarantee thereof by the undersigned; and (e) any other legitimate purpose. If Bank declines this credit application, this consent shall also extend to any prospective credit provider to which Bank may refer such application.

The information submitted on this form is secure and encrypted for your security. Your application is encrypted and then sent securely to Bank of the Ozarks.

Signature
* Printed First Name:
* Printed Last Name:
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