Piermont Bank, A Hybrid Bank for Practical Banking Solutions

STEP 1 OF 4

Name & Company Information

Untitled(Required)

Job Title

Company Name*(Required)

Company Website

STEP 2 OF 4

Contact information

Address*(Required)

Street Address

City

State/Province/Region

Zip Code

Contact Information(Required)

Phone

When is the best time to reach you?

STEP 3 OF 4

Background Information

Where did you hear about us?*(Required)

How can we you help you today?*(Required)

STEP 4 OF 4

Commercial Real Estate Information

Tell us where the property is

Property Address*(Required)

Address Line 2

City

State/Province/Region

Zip Code

Block

Lot

Tell us about the property:

Property Use / Type*(Required)

(Ex: Residential, Retail, Office, Industrial, Mixed-Use)

Property Square Footage*(Required)

Number of Units per type*(Required)

(Ex: 10 Residential, 2 Retail)

Property Financial Information

Estimated Property Value*(Required)

Total Revenue

Net Operating Income*(Required)

Is the property stabilized*?

YES

NO

If so, can you provide a Rent Roll?*(Required)

If not, can you provide proforma projections*?(Required)

Tell us a bit about the business:

Type of Business*(Required)

Year in Business*(Required)

Current Revenue*(Required)

Revenue Last Year*(Required)

Net Profit Last Year*(Required)

Current Bank*(Required)

Do you have a lending relationship with your current bank? If yes, what’s the loan amount?

How much financing are you seeking*?(Required)

We would like to know if you or the business owns any property. If yes, provide info below:

Existing Mortgage Amount (“0” if no mortgage)

Are you interested in a personal or business relationship*?

Personal

Business

Please provide:

Type of Business*(Required)

Avenue Revenue*(Required)

Average Monthly Balance*(Required)

Average Monthly Transaction Volume*(Required)

Any specific product you are looking for*?(Required)

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