Business Continuity Stabilization Fund - Community Futures Centre West

Transcription

1 Business Continuity Stabilization Fund Loan Application Applying for a Business Flood Relief loan from Community Futures Centre West: In response to the recent flooding, CFCWest has established a Business Continuity Stabilization Fund to assist established businesses affected by recent flooding within the CFCWest region. Businesses that qualify can access up to $20, to assist with business rebuilding. These loans will be provided to businesses on a priority bases. In order to access the loan fund, please complete the following application and provide a business recovery plan. completed application to Bruce Tannas, Business Development Advisor busadvisor@cfcwest.com Community Futures Centre West (CFCWest) is a non-profit organization that helps businesses through advising, training, and lending.

2 Business Contact Information Business Name: (Legal Name) Business Number: WCB #: Incorporation #: GST Number: Physical Address: Town: Postal Code: Telephone: Fax: Website: Mailing Address: (If different from above) This Business will maintain: Full Time Employees: Part Time Employees:

3 Business Information List the name(s) and percentage of shares of all principle owner(s) of the business: First Name: Last Name: Percentage of Shares Telephone: Type of Business: (check all that apply) Home Based Proprietorship Incorporated Non-Profit Co-op Retail Service Oil & Gas Manufacturing Forestry Agriculture Tourism Construction Business has been operating since: Business fiscal year end is/will be: Applicant has made best efforts to access funds from the Bank (any charter bank/ credit union) (Initials) Loan Information

4 Amount Requested from CF: Other outstanding CF loan(s) total: Project Funds Used For: Source of Funds Amount % Project Applicant(s) cash contribution Other Sources (1) (specify) Other Sources (2) (specify) CF Contribution Project Total

5 Personal Information of Applicant(s) (Complete this section for each applicant as applicable) Last Middle First Applicant 1 Name: Applicant 2 Name: Home Address: Town/City: Postal Code: Home Phone: Business Phone: Cell: S.I.N: Driver s License #: Birth Date: MM DD YY Are you between the ages of 18 29? Do you rent or own your home? How long at the above address? Rent Own Are You: (check all that apply): A Canadian Citizen Immigrant/Permanent Resident Do you have: Name: Telephone: Life Insurance? Yes No (Amount if Yes) A Lawyer? Yes No

6 An Accountant? Yes No Employment & Education History (Complete this section for each applicant & spouse as applicable) Spouse/Common Law Information Last Name: Middle Name: First Name: Birth Date: MM DD YY SIN # Driver s License # Statement of Income & Expenditures APPLICANT 1 MONTHLY INCOME Your monthly household income (after taxes) from employment $ Other income sources to the household including: Rental Income Child Support Alimony Other (specify) MONTHLY EXPENSES Total monthly income to the household from all sources: Mortgage or rent payment (Include insurance and property taxes) Grocery Expenses Utilities (Telephone, heat, satellite, etc.) Transportation (Gas, insurance, etc.)

7 Insurance (life, disability, critical illness, etc.) Education and Child Care Expenses Entertainment/Hobbies Debt s (Bank loans, credit cards, family loans, etc.) Other Total Monthly Expenses Estimated Savings per month (Total Income less Total Expenses)

8 Statement of Income & Expenditures APPLICANT 2 MONTHLY INCOME Your monthly household income (after taxes) from employment $ Other income sources to the household including: Rental Income Child Support Alimony Other (specify) MONTHLY EXPENSES Total monthly income to the household from all sources: Mortgage or rent payment (Include insurance and property taxes) Grocery Expenses Utilities (Telephone, heat, satellite, etc.) Transportation (Gas, insurance, etc.) Insurance (life, disability, critical illness, etc.) Education and Child Care Expenses Entertainment/Hobbies Debt s (Bank loans, credit cards, family loans, etc.) Other Total Monthly Expenses Estimated Savings per month (Total Income less Total Expenses)

9 Statement of Assets APPLICANT 1 Cash Assets Bank Branch Amount Cash RRSP Stocks/Bonds/GIC s Real Estate (Owned ) Purchase Year Physical Address Owners on Title Price Paid Present Value **Vehicles Year Make/Model Owners on Title Price Paid Present Value Other Assets Year Make/Model Owners on Title Price Paid Present Value **Machinery **Equipment Total Value of Assets

10 Statement of Assets APPLICANT 2 Cash Assets Bank Branch Amount Cash RRSP Stocks/Bonds/GIC s Real Estate (Owned ) Purchase Year Physical Address Owners on Title Price Paid Present Value **Vehicles Year Make/Model Owners on Title Price Paid Present Value Other Assets Year Make/Model Owners on Title Price Paid Present Value **Machinery **Equipment Total Value of Assets

11 Statement of Liabilities APPLICANT 1 Bank Loans Bank Branch Monthly Interest Rate **Line/Credit Overdraft **Mortgages Bank Branch Monthly Interest Rate **Finance Companies Bank Branch Monthly Interest Rate **Stores/credit cards/other Bank Branch Monthly Interest Rate Personal Guarantees Net Worth (Assets minus Liabilities)

12 Statement of Liabilities APPLICANT 2 Bank Loans Bank Branch Monthly Interest Rate **Line/Credit Overdraft **Mortgages Bank Branch Monthly Interest Rate **Finance Companies Bank Branch Monthly Interest Rate **Stores/credit cards/other Bank Branch Monthly Interest Rate Personal Guarantees Net Worth (Assets minus Liabilities)

13 Statement of Assets COMPANY/CORPORATE (to be fill out for existing businesses only) Cash Assets Bank Branch Amount Cash1 Bank Account Stocks/Bonds/GIC s Real Estate (Owned ) Purchase Year Physical Address Owners on Title Price Paid Present Value **Vehicles Year Make/Model Owners on Title Price Paid Present Value Other Assets Year Make/Model Owners on Title Price Paid Present Value **Machinery **Equipment Total Value of Assets

14 Statement of Liabilities COMPANY/CORPORATE (to be fill out for existing businesses only) Bank Loans Bank Branch Monthly Interest Rate **Line/Credit Overdraft **Mortgages Bank Branch Monthly Interest Rate **Finance Companies Bank Branch Monthly Interest Rate **Stores/credit cards/other Bank Branch Monthly Interest Rate Total Value of Liabilities Net Worth (Assets minus Liabilities)

15 Business Overview Community Futures Centre West s (CFCWest) loan process involves careful review of the applicant s financial situation, the applicant s company s financial situation, business recovery plan, and the businesses management team. This Business Overview is designed to give CFCWest a picture of your business and its needs in order to assist with the loan approval process. 1) Describe the major products and/or services the business offers: 2) Describe who your business s customers are: 3) Describe what your business s competitive advantage is (i.e. Why would customers buy from your business vs. the competition or substitute product/service):

16 4) The management team: a) What skills related to running a small business and the business s industry do the company s owner(s)/manager(s) have? b) Who is/will be responsible for the major management functions of the business? Function: Financial Management HR Management Marketing Management Operations Who: c) What skill(s) related to running a small business and/or the business s industry need improvement? How do the owners plan to ensure that any skill deficits are rectified? 5) What are the business s strengths? 6) What are the business s weaknesses?

17 7) What are the current or future opportunities for the business? 8) What are the current or future threats to the business or industry? 9) Describe how your business was impacted by the flood (direct and indirect impacts): 10) Describe what you plan to use the loan financing for: 11) Type(s) of financing needed (check all that apply): Operating line of credit Term loan (purchase equipment or improvements) Inventory loan (purchase stock) Other

18 Supporting Documents (The following documents are required in order to support your loan application) All Applicants: Completed Business Recovery Plan including: Pro Forma cash flow, income statement, and balance sheet. (2 year projections) For business applicants affected by flood water; provide insurance policies and details of applications for flood relief Financial Statements for previous two years (Review Engagement preferred, or Notice to Reader (NTR)). List of equipment at fair market value (equipment must be in working order) Please Note: In some cases, additional documentation may be requested in order to help support your application for financing. Upon approval of your loan application, Community Futures Centre West will require additional documentation prior to disbursal of loan funds.

19 Declarations (Complete this section for each applicant and spouse) Have you ever had any assets repossessed? Yes No Have you ever declared for bankruptcy? (If Yes please list date discharged) Yes No Are you party to any claims or lawsuits? Yes No Are applicants or associated companies involved in ANY legal action or litigation? Yes No Do you owe any personal taxes prior to the current year? Yes No Do you owe any corporate taxes prior to the current year? Yes No Are you related to any Director or Employee of this Community Futures Office? Yes No Do you wish to receive monthly newsletters via from CFCWest? If Yes please provide your address: Yes No

20 The statements made herein are for the express purpose of obtaining financing from Community Futures Centre West (CFCWest) and are to the best of my/our knowledge and belief true and correct. The applicant understands that additional information, if required in support of this application, must be supplied to CFCWest before consideration can be given to this application. The Applicant and if applicable, the guarantor(s), certify that the information reported in this document is true, accurate and complete, and acknowledges that CFCWest will be relying on the information in considering this and future applications for financing. If untrue, inaccurate or incomplete information is provided, CFCWest may, at is sole discretion, decline a loan application or, if a loan has already been granted, may cease disbursement of funds and demand the full repayment of loan proceeds already disbursed. The applicant agrees to reimburse CFCWest legal costs incurred in the registration of documents for loan security. Should the applicant withdraw his request for funds after legal documents have been registered and cost incurred, the applicant shall be responsible for these costs. Your signature on this form provides us with the consent to conduct any credit investigations we deem appropriate and authorizes us to release any information, financial, personal or otherwise, as required for the purposes of a credit investigation, to any organizations. Your signature on this form grants any such organization we contact, permission to provide all information requested to us with respect to our credit investigation.

21 We will continue to collect, use and disclose your personal information until such time as your loan has been repaid. This may include doing further credit checks during the term of your loan and using and disclosing your personal information in order to collect any debts you owe to us. Consent(s) to Inquiry: The Applicant and if applicable, the guarantor(s), consent to Community Futures making any inquiries, including obtaining personal, corporate and business information about them (and their directors and officers, if incorporated, with the corporation declaring it has the authority to provide such consent on their behalf) from such persons, firms, corporations, government authorities, institutions or agencies as it deems necessary in order to reach a decision on any application and to administer an eventual loan, if such is the case. The undersigned consent to CFCWest exchanging information with other financial institutions or financial partners regarding any project under consideration. While the Applicant and if applicable, the guarantor(s), are not required by law to consent to such inquiries and to such information being obtained, their refusal to consent may prevent CFCWest from considering an application for financing. Pursuant to the provisions of the Privacy Act, subject to certain exceptions, the Applicant and if applicable, the guarantor(s) (and their directors and officers, if incorporated), have the right of access to, and protection of, personal information that may be obtained by CFCWest. The foregoing information is submitted for the purpose of establishing or maintaining credit with Community Futures Centre West and is a true, full and correct statement of my financial condition on the date shown. 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.

22 Applicant s Signature Applicant s Name (Print) Date Applicant s Signature Applicant s Name (Print) Date Application must be signed before it can be processed.

23 Notice of Disclosure of your credit information to a credit reporting agency Community Futures Centre West (CFCWest) may give information about you to Equifax, a credit reporting agency for the following purposes: to obtain a consumer credit report about you; and/or to allow Equifax to create or maintain a credit information file containing information about you. This information is limited to the following: Identity particulars - your name, date of birth, sex, and address (and the previous two addresses) and Social Insurance Number (SIN). Period to which this understanding applies: This information may be given before, during or after the provision of credit to you. Seeking commercial credit history information Individuals Agreement to CFCWest using consumer credit information to assess a commercial credit application: I/we agree that CFCWest may: action obtain information about me/us from a business which provides information about the commercial credit worthiness of persons purpose for the purpose of assessing my/our application for consumer credit Signature: Date: SIN: Full Name: Birth Date: All Previous Aliases and/or Maiden Name(s) Address: Witnessed by: Date: Signature: Date: SIN: Full Name: Address: Witnessed by: Date: