Northwestern Bank Online Business Loan Request

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

State — Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Phone Number of Business

Business Contact Information

Contact Name *

Title of Contact

Mailing Address

City

State — Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

E-mail *

Phone Number*

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

Amount of time in operation