Business Loan Application Form

Full Business Name*

Business Location* Phnom Penh Banteay Meanchey Battambang Kampong Cham Kampong Chhnang Kampong Speu Kampong Thom Kampot Kandal Kep Koh Kong Kratie Mondul Kiri Oddar Meanchey Pailin Preah Sihanouk Preah Vihear Prey Veng Pursat Ratanak Kiri Siemreap Stung Treng Svay Rieng Takeo Tboung Khmum

Full Address*

Email

Annual Net Income (in USD)

Full Name*

Position in the Company*

Phone Number*

Loan Amount (KHR)*

Preferential Branch Location* Phnom Penh Banteay Meanchey Battambang Kampong Cham Kampong Chhnang Kampong Speu Kampong Thom Kampot Kandal Kep Koh Kong Kratie Mondul Kiri Oddar Meanchey Pailin Preah Sihanouk Preah Vihear Prey Veng Pursat Ratanak Kiri Siemreap Stung Treng Svay Rieng Takeo Tboung Khmum

Loan Purpose* Existing business expansion Starting additional business Refinancing from another institution Other