PRINCIPAL'S NAME:

Title:

Company Name:

Street Address:

City:     Province/State:     Postal/Zip:

Telephone:     Cellular Phone:

Fax:     E-mail:

Start-up     Existing Business    Years in Business

Sole Proprietorship     Partnership     Corporation

Industry:

Amount of Financing Requested:

Purpose of Financing:

  Equipment Financing

  Start-up Financing

  Working Capital

  Receivables Financing

  Factoring

  Franchise Purchase

  Other:

Briefly Describe purpose of Financing: 

Personal Guarantees Available: Yes      No

Credit History of Owner: Excellent Satisfactory Poor

Credit History of Company: Excellent Satisfactory Poor

If a Business Purchase: Purchase Price $   

Cash Invested by Buyer $

Total Business Assets $

Total Business Liabilities $

Total Business Net Worth $

Company's Annual Revenue $

Company's Annual Net Profit $

How did you hear about this website?