Business Loan Form
  Principal's Name   Company Name  
  Street Address   City  
  Province   Postal Code  
  Telephone   Fax  
  E-mail        
             
  Start-up Business   Years in Business  
  Type of Business   Industry  
  Amount of Financing $   Purpose of Financing  
             
  Start-up Financing Yes No   Working Capital Yes No  
  Receivables Financing   Factoring  
  Other   Personal Guarantees Available Yes No  
             
  Cash Invested $   Total Assets $  
  Total Liabilities $   Total Net Worth $  
  Annual Revenue $   Canada Sales $  
  U.S. Sales $   Other Sales $  
             
 

Briefly Describe Purpose of Financing: