Fields marked with an asterisk (*) are required.

Amount Requested*

Purpose of Loan *

Requested Term

Requested Payment

Requested Repayment Term

Are you an existing Northwestern Bank customer?
  Yes       No    

Account Type   Personal       Business    

Name on Account

Borrower (Business or Owner Name) Is this a new, existing or potential business?
  New       Existing       Potential    

Address of the Business

City

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Zip

Phone Number of Business

Business Contact Information

Contact Name *

Title of Contact

Mailing Address

City

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Zip

E-mail *

Phone Number*

Best Contact Method * Please choose your preferred method of contact — Phone E-mail

Amount of time in operation