# Skaha Lake Road, Penticton, BC V2A 6G5 Phone (250) ~ Toll Free Fax (250) ~

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1 # Skaha Lake Road, Penticton, BC V2A 6G5 Phone (250) ~ Toll Free Fax (250) ~ Thank you for contacting Community Futures for your financing needs. To expedite your application for financing, please complete, sign and return the attached form as soon as possible. Required Documentation for a Loan Application CFDC Loan Application Form, completed & signed by all partners or shareholders (and spouses) Business Plan (including a cash flow projection for at least 24-months) For an Existing Business Financial Statements (Balance Sheet & Income Statement) and/or Tax Returns for last 3 yrs For a Start-Up Business, provide market survey and letters of support from potential customers or clients Equipment List (make, model, serial #, photos) Additional items may be required before your application can be processed. These may include: Resume(s) Vehicle Registrations Driver s License Lease Agreement Mortgage Balance Statement Accepted Offer to Buy (subject to financing) Proof of Certification, Licensing, Training Shareholder Agreement Property, Equipment or Business Appraisals Tax Returns (Personal and/or Corporate) All applications and business plans are reviewed by CFOS staff, to make sure they are Board ready. Our staff are experienced business counselors, and are qualified to assist you with your planning. Once the proposal is ready, the CFOS Loan Review Board meets and reviews the proposal. Please allow approximately 2 weeks for response to your loan application. The Board is made up of volunteer members, each of whom have many years of experience operating profitable businesses themselves. The Board has final decision regarding approval. For further assistance with your loan application, please contact: Imre Togyi Loans Analyst imre@cfokanagan.com Tel:

2 # Skaha Lake Road, Penticton, BC V2A 6G5 Phone (250) ~ Toll Free Fax (250) ~ A P P L I C A T I O N F O R F I N A N C I N G Date of Application: Loan #: (for CFDC use) Name of Applicant(s): Incorporated to be Incorporated Sole Proprietorship Partnership Company Name: Business Number / HST #: Company Address: Town / City: Postal Code: Business Phone #: Business Fax #: Cell #: Amount of Loan Requested: # of Jobs Created: Purpose of Loan: Start-Up Expansion Existing Business Re-Financing Other Loan Fund: Youth (18-34yrs) Regular Entrepreneurs With Disabilities Community Business Loan Fund: Forestry, Aquaculture, Manufacturing, Innovative Technologies, Developing Clean or Renewable Energy (biogas, hydro, solar, biomass, etc), Tourism Have you applied for funds elsewhere? If Yes, where? (circle one) YES NO How did you hear about Community Futures Okanagan Similkameen? Radio Magazine Newspaper Past client SEEB Program Economic Gardening Project Website Chamber of Commerce Referred by (person/organization): Other (please explain) The undersigned declare(s) that the statements made herein are for the purpose of obtaining business financing and are to the best of my/our knowledge true and correct. The applicant(s) consent to the Community Futures Okanagan Similkameen making any inquiries it deems necessary to reach a decision on this application, and consent(s) to the disclosure at any time of any credit information about me/us to any credit reporting agency or to anyone with whom I/we have financial relations. I/we further confirm that I/we will be responsible for payment of all charges relative to investigation preparation execution and registration of such documents as may be required by the Corporation or its solicitors. X Applicant X Co-Applicant (or Spouse)

3 PERSONAL INFORMATION Last Name: First Name Middle Initial Date of Birth: Social Insurance # Home Address: MM/DD/YYYY Home Phone # Unit # Street City Prov Postal Code How long at this address: Residence: Previous Address if less than 3 years at above address: Yrs: Months: Rent Own Occupation: Current Employer: Employer s Phone #: Gross Income: Length of Employment: $ Yrs Mnths Previous Occupation: Previous Employer: Employer s Phone #: Reason For Leaving: Length of Employment: Yrs Mnths Marital Status: Married Common-law Divorced Single Number of Dependents (and ages): Spouses Last Name: First Name Middle Initial Date of Birth: Social Insurance #: MM/DD/YYYY Spouse s Occupation: Spouse s Employer: Employer s Phone #: Gross Income: Length of Employment: $ Yrs Mnths Have you ever had an asset repossessed? Yes No If Yes to any of these questions, please explain: Are you party to any claims or lawsuits? Yes No Have you ever declared bankruptcy? Yes No Do you owe any taxes prior to the current year? Yes No Are you currently a co-signor? Yes No Do you carry Life Insurance? Yes No If Yes, Amount: BUSINESS INFORMATION Business Number: $ This is a Cash Term Name and Address of Lawyer: Name and Address of Accountant: Name and Address of Bank(s) & Account # s: Name and Address and Tel # of Landlord: Is the business providing support for obligations not listed on its financial statements? (ie. Cosigner, endorser, guarantor) Yes No 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? (ie. Sales tax, payroll tax, income tax, WCB, employment standards, etc.) If Yes to above, Amount Owed? $ Owed to: Details of any of the above: Yes No

4 PERSONAL FINANCIAL INFORMATION PERSONAL ASSETS (If married, include assets of both self and spouse): BANK BRANCH ACCOUNT # AMOUNT CASH HOLDINGS Stocks & Bonds: Description: : $ Civic Address +/or Legal Registered Description Owner(s) OWNED REAL ESTATE Year Purch Mortgage Holder or Free & Clear VEHICLE(S) Year, Make, Model Registered Owner Lien or Free & Clear PERSONAL ITEMS ITEM (include household effects, boat, RV, Trailer, etc. Lien or Free & Clear OTHER ASSETS RRSPs Yourself: Spouse: GROSS ANNUAL INCOME: OTHER INCOME Yourself: Spouse: PERSONAL LIABILITIES (If married, include liabilities of both self and spouse): BANK Monthly Payment Months Remaining Collateral Interest Rate Balance Owing BANK LOANS MORTGAGE(S) CREDIT CARDS OTHER DEBTS & LIABILITIES HOUSEHOLD EXPENSES Other than the debts indicated above, how much do you spend a month to live, such as: Rent: Food: Utilities: Phone: Daycare: Medical: Other: PERSONAL FINANCIAL STATEMENT (from totals above) ASSETS AMOUNT LIABILITIES AMOUNT Cash, Stocks & Bonds $ Bank Loans $ Owned Real Estate $ Mortgages $ Vehicles $ Credit Cards $ Personal Items & Household Effects $ Other Debts & Liabilities $ Other Assets $ TOTAL LIABILITIES (B) $ RRSPs $ TOTAL ASSETS (A) $ TOTAL ASSETS (A) $ Minus TOTAL LIABILITIES (B) - $ Equals TOTAL NET WORTH $

5 RELEASE, WAIVER AND INDEMNITY IN CONSIDERATION OF COMMUNITY FUTURES OKANAGAN SIMILKAMEEN (CFOS) providing to (the Undersigned ) financial assistance and/or counseling services in connection with the organization and operation of the business of the Undersigned, the Undersigned, through and by his authorized representative, does hereby release and absolutely discharge CFOS and each of its officers, agents and employees, arising in tort, contract and otherwise, in respect of any and all loss, damage, cost or expense arising out of any activities coordinated or carried out by CFOS, and whether or not any such loss, damage, cost or expense arises in whole or in part from the negligence or neglect of CFOS, its officers, agents or employees or otherwise howsoever; AND the Undersigned hereby covenants and agrees to indemnify and save harmless CFOS and each of its officers, agents and employees from and against any and all claims, actions causes of action (including without limitation any claim, action or cause of action with respect to the operation or failure of the business of the Undersigned), demands, costs, charges or expenses in respect of any and all loss or damage suffered by or happening to the Undersigned arising out of or in any way attributable to the activities coordinated or carried out by CFOS whether or not any such loss or damage in whole or in part arises from the negligence or neglect of CFDCOS or its officers, agents or employees or otherwise howsoever. The Undersigned hereby waives any and all rights which it now has or may in the future have to claim against CFOS, its officers, agents or employees arising out of or in connection with any of the activities or services provided by CFOS. This Release and Indemnity shall be binding upon the Undersigned and his estate, heirs and successors. DATED this day of, 20. X Witness Address Occupation X X Applicant or Authorized Signatory of company Co-Applicant (or Spouse)