Application Form

Application Form

fund

Credit Application
Applicant/Owners Personal Information
Full Name*
First Last
Email*
Phone Number*
Date of Birth*
MM slash DD slash YYYY
EIN Number*
Address (No PO Boxes)*
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Have you ever declared bankruptcy?*
- Yes
- No
Do you owe any taxes for the current or previous tax years?*
- Yes
- No
Do you have any claims or lawsuits?*
- Yes
- No
Do you own or rent your primary residence?*
- Own
- Rent
Company Information
What kind of business do you have?*
- Corperation
- Partnership
- Propriatorship
- Other
Legal Business Name*
Doing Business As (DBA)
Type of Business*
GST/HST or Tax Number*
Business Phone #*
Business Inception Date*
MM slash DD slash YYYY
Business Address (No PO Boxes)*
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shareholder #1 Name*
First Last
Percentage Owned*
Shareholder #2 Name (if applicable)
First Last
Percentage Owned
Website (leave blank if not applicable)
Gross Annual Business Revenue*
Avergae Bank Balance*
Desired Loan Amount*
Number of Deposits Per Month*
Desired Term Length
Do You Have A business Checking Account?*
- Yes
- No
Do You Have an Outstanding Merchant Cash Advance?*
- Yes
- No
Do you accept more than 50% of your sales on credit or debit card?*
- Yes
- No
Do you rent or own your business building?*
- Own
- Rent
Landlord Name (if renting)
Landlord Phone # (if renting)
Owner #2 Information (if applicable)
Full Name
First Last
Email
Phone Number
Date of Birth
MM slash DD slash YYYY
SIN Number
Address (No PO Boxes)
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Have you ever declared bankruptcy?
- Yes
- No
Do you owe any taxes for the current or previous tax years?
- Yes
- No
Do you have any claims or lawsuits?
- Yes
- No
Do you own or rent your primary residence?
- Own
- Rent
Optional - Attach 6 months of bank statements here (PDF format)
Drop files here or

Max. file size: 2 GB.
“The personal information may be gathered and used by a third party and its assignees and potential assignees, to provide products and to perform services as may be requested by you. We may also disclose your personal information to third parties such as the manufacturer of your vehicle, credit reporting agencies, financial institutions of financing companies, your insurance agent or company and/or companies which provide or insure warranties relating to your vehicle. You are entitled to access this personal information that you provide and you may ask that it be updated and rectified. I acknowledge that the information, including personal information, may be processed and stored outside of Canada. We may also disclose your personal information where we are permitted by law to do so. By signing this document below, you have consented to these uses and disclosures.”
Owner #1 Signature*
Owner #2 Signature
Date*
YYYY dash MM dash DD

fund

Credit Application

Company Information

Owner #2 Information (if applicable)

Apply for funding

Application received