Legal Corporate Name*
Trade Style..................
Main Contact............*.. Title:
Address....................*.
City...........................* Prov *: Ont BC Alta Sask Man Que NB NS PEI Nfld Nan NWT Yuk PC: *
Voice Phone..............*.Fax:
E-Mail........................*.
Years in Business:...... *If Incorporated - Date:MMM/DD/YY
Type of Business....... * Corporation Partnership Proprietorship Non Profit Church Government Other Other:
Premises Owned?: Yes No
Mortgage holder/Landlord:
& Address of Same........& Ph:

Describe business

OWNERSHIP DETAILS

Name: .......*

Title:............% Owned: *
If business not incorporated - Date of Birth:SIN:
Name: ......*

Title:...........% Owned: *
If business not incorporated - Date of Birth:SIN:
Name:........

Title:..........% Owned:
If business not incorporated - Date of Birth:SIN:

MARKET PLACE

Provide information on your three largest clients

Name:Years % of Ann Sales:
Name:Years % of Ann Sales:
Name:Years % of Ann Sales:

Market Territory:.. Community City Golden Horseshoe SW Ont E Ont Central Ont N Ont Ontario Quebec NB NS PEI Nfld Ont Que Maritimes Ont, Que Maritimes Que Maritimes Man Sask Alberta Prairies BC W Canada Canada Canada US Worldwide
Or describe........:

BANK INFORMATION

Bank...........:Branch:
Account Mgr:Bank Ph:

FINANCIAL INFORMATION

The following information is optional but does assist in getting your credit approved. If you are applying for over $25,000 Financial statements will usually be required (by e-mail or snail mail)

Application for Amount in excess of $25,000. F/S being provided

Will send F/S by Mail by E-Mail or you can access at my WEB site which is (your Web site URL would be appreciated anyway!)

OR

Annual Sales Range (per latest fiscal Statements)... Select Under $25M $25M-$50M $50M-$100M $100M-$250M $250M-$500M $500M-$750M $750M-$1MM $1MM-$2MM $2MM-$5MM Over$5MM 1st Year Not Available ("M" = thousands "MM" = millions!)
Sales Trend Up Flat Down

Shareholder's Equity (including Shareholder Loans) Select Under $25M $25-$50M $50-$100M $100-$250M $$250M-$500M $500M-$750M $750M-$1MM $1MM-$2MM $2MM-$5MM Over $5MM Deficit Not Available ("M" = thousands "MM" = millions!)

TRADE REFERENCES

Name:.Product:
Phone:Contact:
Name:.Product:
Phone:Contact:
Name:.Product:
Phone:Contact:

LEASE DETAILS

Vendor Name  *
Address..........
City...............* Prov: Ont BC Alta Sask Man Que NB NS PEI Nfld Nan NWT Yuk PC:
Voice Phone....Fax:

Describe Equipment *
enter year, new or used, make & model & describe if specialized industry item

Price................*..Cdn$ Exclude PST & GST/HST
Lease Term .....*. Select 24 Months $1 Option 30 Months 20% Option 36 Months $1 Option 42 Months 20% Option 48 Months $1 Option 54 Months 15% Option 60 Months $1 Option 65 Months 10% Option Term & Option may differ where FMV warrants

Authorized by Name & Title

Or