PRELIMINARY APPLICATION Loan [ ] Lease [ ]
Amount of financing needed ________________(minimum $5,000)
Describe how your company will use the financing:_______________
______________________________________________________
______________________________________________________Information about your Company :
Company Name: ___________________________________________________
First Name:______________________Last Name:_________________________
Position:__________________________________________________________
Company Street Address:_____________________________________________
City:_________________________ State/Province:___________________
Country:______________________ ZIP/Postal Code:_________________
Phone Number:(___)____________ Fax Number:_____________________
E-Mail :______________________ Website:________________________
Description of your Business:__________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Type of Business: (circle appropriate designation)
*Sole Proprietor *Partnership *Corporation *S Corporation *Municipality/Government *Limited Liability Company *Limited Liability Partnership
Federal Tax ID / BIN _________________________________________________
Business Start Date:____/_____mo/yr Number of Employees:_________
Do you have a minimum of 2 years financial statements? yes / no
Are you prepared to give a personal guarantee? yes / no
Do you have a business plan? yes / no
PRINT, FILL OUT & FAX TO : (604) 520 - 6340
INFORMATION ON PRINCIPALS:
The following is required on each of the Shareholders:
1. First Name:____________________ Last Name:__________________________
SSN/SIN:______________________ Percentage of Ownership:________________
Title:__________________________ Net Worth: ___________________________
Street Address:_______________________________________________________
City:_________________________State/Prov:______________________________
Country:______________________ZIP/Postal Code:__________________________
2. First Name:____________________ Last Name:__________________________
SSN/SIN:______________________ Percentage of Ownership:________________
Title:__________________________ Net Worth: ___________________________
Street Address:_______________________________________________________
City:_________________________State/Prov:______________________________
Country:______________________ZIP/Postal Code:__________________________
3. First Name:____________________ Last Name:__________________________
SSN/SIN:______________________ Percentage of Ownership:________________
Title:__________________________ Net Worth: ___________________________
Street Address:_______________________________________________________
City:_________________________State/Prov:______________________________
Country:______________________ZIP/Postal Code:__________________________