Step 1 of 3
(If Real Estate is personally owned, please indicate name of owner below)
One copy of this form needs to be completed by individuals who own 20% or more of the Operating Company and/or Real Estate Holding Company.
The following information is requested by the Federal Government in order to monitor compliance with Federal Law. You are not required to provide it, but are encouraged to do so. This information will not be used to evaluate your application or to discriminate against you in any way. SICOG is an Equal Opportunity Lender
List chronologically, beginning with present employment
To the best of my/our knowledge, the information contained in this application is true and accurate. I/we have not paid anyone for help in preparing this application, nor have we relied on SICOG for the information contained therein. There is no direct or indirect conflict of interest between me/us and SICOG. This application authorizes SICOG and its affiliates to verify any and all of the information contained herein, and to check and and all of my/our credit, wherever it may be.
E-mail: firstname.lastname@example.orgPhone: 208-233-4032 / 800-526-8129
E-mail: email@example.comPhone: 208-233-4535
E-mail: firstname.lastname@example.orgPhone: 208-233-4535
Monday – Friday 8:00 a.m. – 5:00 p.m.
214 E Center Street Suite 10Pocatello, ID 83201Fax: 208-233-5232