BUSINESS LOAN APPLICATION. Borrower s Name: Telephone #:

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1 Borrower s Name: Telephone #: BUSINESS LOAN APPLICATION 110A Slater Road N.W. Cranbrook, B.C. V1C 5C8 Phone: Toll Free Fax:

2 LOAN APPLICATION CHECKLIST In order for Community Futures to consider your loan application, the following items must accompany the loan application. In the event the information is unavailable at the current time, we will be pleased to hold your application for a maximum period of 60 days. 1. Loan Application Fee (Non-Refundable) $ Loans requests up to $25,000 $ Loan requests above $25,000 Cheques payable to Community Futures East Kootenay 2. Brief History of Business (2-3 pages) 3. Business Plan which must also include (Please do not submit your original) Start Up Year 1 and Year 2 Cash Flow Projections (Income & Expense Projections) Expansion/Maintenance Year 1 and Year 2 Cash Flow Projections (Income & Expense Projections) Copy of Business Tax Return Financial Statements Sole Proprietor: Personal Income Tax Return (Last 3 Years) Incorporated: Balance Sheet & Income Statement (Last 3 Years) Business Asset list including values Additional Items Required for All Businesses Most recent copy of Notice of Assessment (Summary form you receive after filing personal income taxes) Letters of Support & References Personal Resume of Operations Ex. Production Volume & Schedule, Prices, Hours of Operation, Procedures, Suppliers, etc. Lease/Rental Agreements (if applicable) Form of Organization (partnership agreement or incorporation documents if applicable) Competitor Analysis 2

3 BUSINESS LOAN APPLICATION PERSONAL INFORMATION BORROWER S INFORMATION First Name: Middle Name: Last Name: Home Address: Apt/Suite #: City: Province: Postal Code: Mailing address: (if different than above) Home Telephone #: Cell #: SIN #: Drivers License #: Birth Date: MM DD YY # of Dependants: Marital Status: Single Common Law Married Separated Divorced Widowed Citizenship: Canadian Citizen Landed Immigrant/Permanent Resident Work/Student Visa or Visitor BORROWER S EMPLOYMENT HISTORY Current or most recent Employer s name: Employer s telephone #: Occupation: Gross Monthly Salary: How long were you employed/have been employed here? BORROWER S REFERENCES (Not to include family members) Name: Relationship: Daytime Telephone: SPOUSE/COMMON LAW INFORMATION First Name: Middle Name: Last Name: SIN #: Drivers License #: Birth Date: MM DD YY SPOUSE/COMMON LAW EMPLOYMENT HISTORY (Complete this section only if spouse is joint applicant) Current or most recent Employer s name: Employer s telephone #: Occupation: Gross Monthly Salary: How long were you employed/have been employed here? 3

4 PERSONAL INFORMATION CONTINUED Do you have a current Life Insurance Policy? Yes No If yes, amount: Have you or your spouse/common law partner ever had an asset repossessed? Yes No Have you or your spouse/common law partner been party to any claim or lawsuit? Yes No Have you are your spouse/common law partner ever declared bankruptcy? Yes No Do you or your spouse/common law partner owe any Statutory Creditors? Yes No PERSONAL STATEMENT OF INCOME & EXPENDITURES INCOME (MONTHLY) Net Monthly Household Income (From Employment) $ Other Income (Specify) $ Rental Income: $ Child Support: $ Alimony: $ Total Monthly Income: $ EXPENSES (MONTHLY) Mortgage/Rent $ Property Taxes & Property Insurance $ Loan Payments (Specify) Expense - Vehicle, RV, Etc. $ 1. $ 2. $ Line of Credit $ Credit Cards (Specify) $ 1. $ 2. $ Groceries $ Utilities Expenses - Telephone, Heat, Hydro, Cable, Cell phone, etc. $ Transportation Expenses - Gas, Vehicle Insurance, etc. $ Personal Insurance Life, Disability, Critical Illness, etc. $ Education & Child Care Expenses $ Entertainment / Hobbies $ Total Monthly Expense: $ Estimated Savings Per Month (Total Income Less Total Expenses) $ 4

5 PERSONAL FINANCIAL INFORMATION (HOUSEHOLD) ASSETS Real Estate Address Current Value Vehicles KMs Current Value Cash Holdings (Ex. RRSP, Mutual Funds, Cash) Financial Institution Amount 1. $ 2. $ Other Assets (Ex. RV, Boat) Current Value Total Current Value $ Total $ ( Total Current Value Total ) TOTAL AVAILABLE ASSETS $ LIABILITIES Real Estate Address Financial Institution Monthly Payment Original Balance $ $ Vehicles Financial Institution Monthly Payment Original Balance Loans Financial Institution Monthly Payment Original Balance $ $ Credit (Ex. Credit Card/LOC) Financial Institution Monthly Payment Original Balance $ $ 3. $ $ $ Other Liabilities Financial Institution Monthly Payment Original Balance (Ex. Credit Card/LOC) $ $ TOTAL LIABILITIES $ (Total Available Assets Total Liabilities) NEW WORTH 5 $

6 BUSINESS INFORMATION Legal Name of Business: Physical Address: Apt/Suite #: City: Province: Postal Code: Mailing address: (if different than above) Business Telephone #: Cell#: Fax #: This business is/will be: Sole Proprietorship Partnership Incorporation Co-Op Non-Profit This business is/will be: Start Up Existing Business Purchase of Existing Business Home Based Business Business Number: Incorporation Number (If Applicable): This business has/will have a fiscal year end in the month of: This business has been operating full-time since OR This business has been operating part-time since This business currently has: full-time employees: part-time employees: seasonal/casual employees: This business is/will be operating in the primary sector of (check one): Agriculture Manufacturing Service Wholesale Tourism/Hospitality Forestry Retail Construction Other List the name(s) and percentage of shares of all principal owner(s) of the business: First Name Last Name % of Shares Is the business providing support for obligations not listed on its financial statements? Yes No (Ex. Consigner, Endorser, Guarantor, etc) Is the business party to any claim or lawsuit? Yes No Has the business ever sought legal protection from its creditors? Yes No Does the business owe any statutory creditors? Yes No (Ex. HST, Source Deductions, Income Tax, Work Safe BC, employment standards, etc,) If yes to above: Creditor: Amount Owed: $ Explanation: Creditor: Amount Owed: $ Explanation: Name of Accountant: Phone #: Name of Lawyer: Phone #: Name of Business Insurance Company: Phone #: Name of Business Bank: Phone #: 6

7 BUSINESS EQUITY STATEMENT ASSETS Real Estate Address Current Value Vehicles KMs Current Value Cash Holdings Type (Ex. RRSP, Mutual Funds, Cash) Financial Institution Amount 1. $ 2. $ Other Assets (Ex. Equipment, Tools) Serial # Current Value Total Current Value $ Total $ ( Total Current Value Total ) TOTAL AVAILABLE ASSETS $ LIABILITIES Real Estate Address Financial Institution Monthly Payment Original Balance $ $ Vehicles Financial Institution Monthly Payment Original Balance Loans Financial Institution Monthly Payment Original Balance $ $ Credit (Ex. Credit Card/LOC) Financial Institution Monthly Payment Original Balance $ $ 3. $ $ $ Other Liabilities (Ex. Credit Card/LOC) Financial Institution Monthly Payment Original Balance $ $ TOTAL LIABILITIES $ (Total Available Assets Total Liabilities) NEW WORTH 7 $

8 LOAN INFORMATION Has the business applied for funds elsewhere? Yes No If yes, which Financial Institution: Reason for decline: How did you hear about Community Futures? Financial Institution (Specify) Website Word of Mouth Other (Specify) The purpose of this loan is for: Start-up Expansion Maintenance The business is requesting: $ The principle owners are personally investing: $ Other Sources of funding: $ Specify: $ is requested from Community Futures East Kootenay. Provide a breakdown of the project costs: Working Capital $ Equipment $ Leasehold Improvements $ Debt Consolidation $ Inventory $ Other $ 8

9 LOAN FEE SCHEDULE Application Fees $ Loans up to $25,000 $ Loans above $25,000 Interest Rate Varies based on multiple factors Ex. Loan size, equity contribution, security/collateral position, level of risk. Loan Disbursement Fees Variable options 2% of Loan Proceeds and up Loan Documentation Fees Any incurred 3rd Party Fees. Ex. Solicitor, Mortgage Broker will be charged. Administration Fees $5.00 Monthly Flat Fee charged on the last day of each month. Annual Review Fees $75.00 Loans up to $25,000 $ Loans above $25,000 $50.00 Late Reporting Fee (Charged Monthly) Loan Amendment Fee* $75.00 Loans up to $25,000 $ Loans above $25,000 Not Sufficient Funds (NSF) $50.00 Flat fee per NSF Early Payout/ Lump Sum Payments If loan is paid out within first year, a 2% fee will be charged on the outstanding balance of the loan. If the loan is paid out after one year no charges will be incurred. Lump sum payments can be applied to the loan at any time without incurring any charges. Discharge Fees 2% fee on outstanding loan balance if loan is paid out within the first year. Legal Fees Any legal fees incurred in relation to the loan will be applied directly to the loan. * Any changes to the initial terms and conditions of the loan will incur a fee for each change. All fees incurred will be applied directly to the loan with the exception of the Loan Application Fees which must be paid in full with submission of loan application. We require notice 15 days prior to scheduled payment to make any changes. Any bank costs incurred will be applied directly to the loan. 9

10 DISCLOSURE AND RELEASE STATEMENT DISCLOSURE AND RELEASE STATEMENT Are you related to any Director or Employee of Community Futures East Kootenay? Yes No The statements made herein are for the express purpose of obtaining financing from Community Futures East Kootenay and are to the best of your knowledge and belief true and correct. The applicant understands that additional information, if required in support of this application, must be supplied to the Community Futures East Kootenay before adequate consideration can be given to this applicant. The applicant agrees to reimburse Community Futures East Kootenay any legal costs incurred in the registration of documents for loan security. Should the applicant withdraw their request for funds after legal documents have been registered and costs incurred, the applicant shall be responsible for these costs. The foregoing information is submitted for the purpose of establishing or maintaining credit with Community Futures East Kootenay and is a true, full and correct statement of my financial condition on the date shown. I hereby authorize Community Futures East Kootenay to obtain any information it deems necessary about me, including but not confined to, reports from credit bureaus, retail credit companies, or any other source that Community Futures East Kootenay deems appropriate. By signing this application, you are consenting to Community Futures East Kootenay (CFEK) for the purposes of making a credit decision, to collect, use and disclose your personal information. Should your application be approved, you are also consenting to collection, use or disclosure of your personal information by CFEK. For the purpose of annual reviews and assessment of your obligation to CFEK, your consent will remain in effect until such time as you provide reasonable notice in writing to CFEK to withdraw your consent. Application must be signed before it can be processed. I, the undersigned, declare that the statements made herein are for the purpose of obtaining business financing and are to the best of my knowledge complete and correct. Borrower s Name (Print) Borrower s Signature Date Borrower s Name (Print) Borrower s Signature Date 10

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