COGECO Fund – Corporate Loan ApplicationRev. November 2005Page 1/9

PLEASE TYPE: (Note: This application is also available in French) This application for must be submitted by email to

Production Company:
Website URL:
Amount Requested
($35,000 maximum): / $
Title of three films (minimum and maximum of 3) on development slate for this application:
1.
2.
3.
Title of films in development NOT included on this application, that may go into production prior to the slate submitted: (insert more rows as needed)
1.
2.
3.
Have you received any other Corporate Development financing from other sources? / Yes / No
If yes, complete the chart below. If no, skip to Section A.
Source / Amount ($)
$
$
$
A. Production Company – Corporate Profile
Number of ….
Feature Films produced
MOWs produced
Mini-Series produced
Other / Specify:
How many of these projects were theatrically released?

Summarize up to 5 of your most successful previous productions: (copy and paste more charts as needed)

Film Title / Genre:
Production Date: / Production Budget: / $
Festivals/Awards: / Revenues: / $
International Distribution (where released):
Film Title / Genre:
Production Date: / Production Budget: / $
Festivals/Awards: / Revenues: / $
International Distribution (where released):
B. Production Company – Strategy

1.What are your development, production and marketing strategies for the next 2 years?

2.How will this corporate loan advance the business plan of your production company?

3.How does your present slate of films reflect your creative objectives?

C. Project Information (space for 3 projects provided – if you are including more, just copy and paste)

Project #1

Current Title of Project:
Genre:
Target Audience:
Is this a co-production? / Yes No / % Ownership
Co-Production Company:
Total Development Budget: / $
Estimated Production Budget:
(if available) / $

Logline:

Synopsis (200 Word MAXIMUM) – DO NOT submit an attachment:

Do you have any confirmed development financing to date for this project? / Yes / No
If yes, complete the chart below.
Source / Amount ($)
$
$
$
$
TOTAL / $
Development Schedule (where applicable):
Stage / Date
Option
Treatment/Outline
Research
1st Draft Script
2nd Draft Script
Polish/Final Draft Script
Casting
Location scouting
Packaging
Marketing Plan
Apply for Production Financing
Production
Other
Key Creative (if available):
Position / Name / Confirmed?
Y/N / CDN? Y/N / List 3 recent credits and any major awards:
Producer
Writer
Director
Story Editor
Performer
Original Material
Distributor

Biography / filmography of the Key Creative Personnel:

Project #2

Current Title of Project:
Genre:
Target Audience:
Is this a co-production? / Yes No / % Ownership
Co-Production Company:
Total Development Budget: / $
Estimated Production Budget:
(if available) / $

Logline:

Synopsis (200 Word MAXIMUM) – DO NOT submit an attachment:

Do you have any confirmed development financing to date for this project? / Yes / No
If yes, complete the chart below.
Source / Amount ($)
$
$
$
$
TOTAL / $
Development Schedule (where applicable):
Stage / Date
Option
Treatment/Outline
Research
1st Draft Script
2nd Draft Script
Polish/Final Draft Script
Casting
Location scouting
Packaging
Marketing Plan
Apply for Production Financing
Production
Other
Key Creative (if available):
Position / Name / Confirmed?
Y/N / CDN? Y/N / List 3 recent credits and any major awards:
Producer
Writer
Director
Story Editor
Performer
Original Material
Distributor

Biography / filmography of the Key Creative Personnel:

Project #3

Current Title of Project:
Genre:
Target Audience:
Is this a co-production? / Yes No / % Ownership
Co-Production Company:
Total Development Budget: / $
Estimated Production Budget:
(if available) / $

Logline:

Synopsis (200 Word MAXIMUM) – DO NOT submit an attachment:

Do you have any confirmed development financing to date for this project? / Yes / No
If yes, complete the chart below.
Source / Amount ($)
$
$
$
$
TOTAL / $
Development Schedule (where applicable):
Stage / Date
Option
Treatment/Outline
Research
1st Draft Script
2nd Draft Script
Polish/Final Draft Script
Casting
Location scouting
Packaging
Marketing Plan
Apply for Production Financing
Production
Other
Key Creative (if available):
Position / Name / Confirmed?
Y/N / CDN? Y/N / List 3 recent credits and any major awards:
Producer
Writer
Director
Story Editor
Performer
Original Material
Distributor

Biography / filmography of the Key Creative Personnel:

D. Acknowledgement, Disclaimer and Sign-Off

Please ensure that your application meets the requirements of the Cogeco Program Development Fund Guidelines.

This application form must be completed in full and emailed to the Fund () to be considered for funding. No attachments, other than this application form itself, will be accepted. You may write a cover letter in the body of the email itself. The Cogeco Program Development Fund may, at its discretion, request back-up documentation, agreements, budgets, options and rights agreements, distribution agreements, proof of financing, incorporation documents etc.

The applicants hereby warrant that the information provided in this Application Form is complete and accurate and that the signatory has the full authority to submit this application to the Cogeco Program Development Fund.

The applicant hereby authorizes The Cogeco Program Development Fund to communicate any information in this application with any third party indicated in this application as a proposed or committed source of financing for this project.

Contact Name:
Title:
Address (in full):
Telephone:
Fax:
E-Mail
Authorized Signature: / Date:
Title: