Business Financing Application | Thousand Islands Community Futures Development Corporation

PLEASE NOTE: Any fields with * indicate "REQUIRED" and must be filled in. If any field is NOT APPLICABLE enter either a "NA" (not applicable) or "0" (the number 0).

1. Applicant Information

COMPANY NAME *

Telephone *

Company Address: *

City / Town and Province *

Postal Code *

Email *

Fax

2. Business / Organization Information

CARRYING ON THE BUSINESS OF: *

3. HEREBY APPLIES TO 1000 Islands Community Development Corporation (the “Corporation”)

for financing of *

under the following project to be financed:

ESTIMATED PROJECT COSTS:

Land *

Building/Leaseholds *

Equipment *

Working Capital *

Other Costs

Other Cost Amount

Total of All Costs *

Please calculate your total Project Costs listed above

EXPECTED FINANCING:

1000 Islands CDC Loan *

Investment by the Owners *

Other Financing *

Grants *

Other Expected Financing *

Total Expected Financing *

Please calculate your total of Expected Financing listed above

4. AND MAKES THE FOLLOWING STATEMENTS:

(a) That the Applicant’s business was established:

Day *

Month *

Year *

(b) As: *

If Other was chosen

(c) That the Officers and shareholders of the Applicant’s business are:

Full Name (Officers 1) *

Address *

Position / Office *

% Interest *

Years with Firm *

Additional Officers / Shareholders (2)

Add additional Officers and Shareholder fields

Full Name (Officers 2) *

Address *

Position / Office *

% Interest *

Years with Firm *

Additional Officers / Shareholders (3)

Add additional Officers and Shareholder fields

Full Name (Officers 3) *

Address *

Position / Office *

% Interest *

Years with Firm *

(d) That a partnership agreement was executed and is attached:

*Note: each partner is required to complete a Statement of Personal Assets and Liabilities with this application. A PDF of this Personal Assets and Liabilities form is available here

(Date executed* or No) *

Day, Month Year OR No

(d) (e) That this project is expected to influence the following:

New Jobs Created *

Jobs Maintained *

(f) That conventional financing was unavailable for this business proposal:

Yes

No

(g) That the Applicant will notify the Corporation immediately of any application pending and under consideration by another lender, or if negotiations are entered into, or an offer of financing is received, during the period of the Corporation’s consideration of this application.

(h) That the Applicant carries a bank account(s) at:

Name of Bank *

Bank Address *

Name of Bank *

Bank Address *

and will instruct the bank(s) to give the Corporation full information concerning the Applicant’s affairs.

(i) That there has been no material adverse change in the financial position or operations of the Applicant since

Day *

Month *

Year *

, being the end of the last fiscal year of the Applicant for which a balance sheet and a profit and loss statement have been furnished.

(l) That there is no litigation in course or threatened, nor any proceedings before any court, tribunal, governmental board of agency now in course or threatened, and that there is no unexecuted judgment rendered against the Applicant, except:

litigation in course or any proceedings before any court *

(Litigation/proceedings involving the Applicant and/or any close related individual or corporation should be reported.)

5. THE APPLICANT UNDERSTANDS AND AGREES:

(a) That the Applicant will be responsible for payment of all charges relative to preparation, execution and registration of such documents as may be required by the Corporation or its solicitors and encloses a

non-refundable application fee *

non-refundable application fee with this application;

(b) That the terms and conditions of any financing w hich may be authorized w ill be set forth in a Letter of Offer, for agreement and acceptance by the Applicant;

(c) That the statements made herein are for the express purpose of obtaining financing from the Corporation and are to the best of the Applicant’s knowledge and belief true and correct. The Applicant understands that additional information in support of this application must be supplied to the Corporation, if requested, before adequate consideration can be given to this application. The Applicant realizes that any present or future indebtedness of the Applicant, or the Applicant’s business, to the Corporation may become due and payable if any information provided by the Applicant to the Corporation proves to be inaccurate or incomplete;

(d) That in applying for this financing and, in the event that the Corporation approves such application, the Applicant’s personal and confidential business information will be requested from the Applicant and/or collected from third parties that have information about the Applicant’s business and personal financial status for the purposes of determining the Applicant’s eligibility for financing and reporting to Industry Canada.

6. DISCLOSURE, RELEASE AND WAIVER OF LIABILITY

a) The Applicant acknowledges that he or she approached the Corporation to obtain information about business and has, or is preparing a business plan.

(b) The Applicant acknowledges receipt of the Corporation’s Privacy Statement and hereby consents to his or her personal and business information being collected, used, retained, and disclosed by the Corporation for the limited purposes as set out above. The Applicant further understands that under Federal privacy law, he or she has access to the information held by the Corporation and knows to refer to the Corporation’s Privacy Policy or contact the Chief Privacy Officer if a question or concern arises about the handling of the Applicant’s personal information.

(c) The Applicant further understands and consents to the Corporation publicizing the Applicant’s business venture if the Applicant is successful in obtaining financing from the Corporation, w hich may or may not include personal information such as the name of the Applicant.

You must AGREE with the above conditions by checking this box *

YES I have read and agree to conditions outlined above

Authorized By *

Name of Applicant / Person Applying on Behalf of Company

Title *

Date *

YES I have authority to bind the Corporation

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