Credit Application

All Information Contained Herein Shall Be Considered Confidential:

Date: ______Title:______

Legal Name: ______Phone:______

Operating Name: ______Fax:______

Company Contact: ______Cell:______

Address: ______Email:______

City, Prov., P.C. ______

Describe your company and the business you do: ______

______

How did you find out about us? ______

Sole ProprietorPartnership LLCCorporation

Corporation #:

Date established: ______Years in present ownership:______

2015 Annual Revenue:______2016 Annual Revenue: ______

Amount of funding requested$ ______Preferred loan type: ______

(Examples of loan types: Business Term Loan, Line of Credit, Merchant Cash Advance, Invoice Factoring, Commercial Mortgage)

If you have chosen a Merchant Cash Advance, what is your average monthly summary total: $______

What will the funds be used for: ______

______

Principals of The Company:

Officer 1 Name:______Title: ______

SIN#:______Date of Birth: ______Home Address: ______Signing Authority: Yes______No ______Percentage Owned: ______

Officer 2 Name:______Title: ______

SIN#:______Date of Birth: ______Home Address: ______Signing Authority: Yes______No ______Percentage Owned: ______

Officer 3 Name:______Title: ______

SIN#:______Date of Birth: ______Home Address: ______Signing Authority: Yes______No ______Percentage Owned: ______

please list ‘2’ Supplier References:(Companies who give you credit) If you do not receive credit from any company(s), leave blank

1. Name: ______

Telephone Number:______

Business Name:______

Association with you:______

2. Name: ______

Telephone Number:______

Business Name:______

Association with you:______

* Please Rate Your Credit For Us Between 1 & 10, with 1 being poor & 10 being excellent: ______

Banking Information:

Name of Bank:BranchAddress: ______

Chequing Acct #:Contact Person: ______

Are any company assets pledged as security?

Circle all that apply.: Accounts Inventory Equipment Invoices None

Bank Loans:______Collateral: ______

Have you ever had any personal or corporate Litigation/Judgment? Yes  No

(If Yes, please describe here) ______

Have you ever been convicted or found guilty of an offense under any law or are any charges now pending?

If yes, please attach full particulars on a separate sheet signed and dated statement.  Yes  No

Have you ever gone insolvent?  Yes  No

The foregoing information is true and correct to the best of my knowledge and is given to induce Capital Credit Canada’s lending partners to consider entering into a financing agreement with this company. I hereby authorize Capital Credit Canada’s lending partners or their agents to verify and investigate any or all of the foregoing statements, including but not limited to my/our credit worthiness and financial responsibility. I/We grant Capital Credit Canada’s lending partners the right to procure any and all credit reports pertaining to any party listed in this application, including, but not limited to, all principals of the applicant company.

Agreed and consented to:

Signature: ______Print Name: ______

Title: ______Date: ______

Signature: ______Print Name: ______

Title: ______Date: ______

Signature: ______Print Name: ______

Title: ______Date: ______

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