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COMMERCIAL CREDIT & EQUIPMENT FINANCING

APPLICATION

Thank you for your interest in our commercial financing services. Please complete all applicable sections. Providing accurate and complete information may help accelerate the review process.

SECTION 1 — BUSINESS INFORMATION

Legal Business Name:*

Operating / Trade Name (if different):*

Business Structure:*

Corporation

Sole Proprietorship

Partnership

LLP

Other

Year Business Established:*

Number of Employees:*

Business Industry / Description:*

SECTION 2 — BUSINESS ADDRESS

Street Address:*

City:*

Province / State:*

Postal / ZIP Code:*

Country:*

SECTION 3 - PRIMARY CONTACT

Contact Name:*

Position/Title:*

Business Telephone:*

Mobile Number:*

Email Address:*

SECTION 4 - FINANCING REQUEST

Type of Financing Requested: *

Equipment Lease

Equipment Loan

Working Capital

Receivables Financing

Requested Financing Amount ($)*

Equipment / Asset Description:*

SECTION 5 - BUSINESS OWNERSHIP

Principal Owner / Shareholder #1

Full Name:*

Ownership Percentage:*

Home Address:*

Phone Number:

Email Address:

Principal Owner / Shareholder #2

Full Name:*

Ownership Percentage:*

Home Address:*

Phone Number:

Email Address:

SECTION 6 - FINANCIAL INFORMATION

Estimated Annual Revenue: *

Under $100,000

$100,000-$500,000

$500,000-$1,000,000

Over $1,000,000

Existing Business Debt: *

Yes

No

Approximate Amount:*

Has the business or any principal ever declared bankruptcy or insolvency?*

Yes

No

If yes, provide details:

SECTION 7 — BANKING INFORMATION

Financial Institution:*

Branch Location:*

Business Account Held Since:*

SECTION 8 - APPLICANT DECLARATION & AUTHORIZATION

The undersigned certifies that the information provided in this application is true and complete to the best of their knowledge.

The applicant authorizes the finance provider and its designated representatives to verify information provided in connection with this application, including business credit, banking, trade, and financial references where permitted by law.

Submission of this application does not guarantee approval or funding.

Authorized Signatory:*

Title:*

Signature:*

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