CONSULTANT AGREEMENT



Credit Application

All Information Contained Herein Shall Be Considered Confidential:

Date: ______________________________ Title: _______________________________

Legal Name: ______________________________ Phone: _______________________________

Operating Name: ______________________________ Fax: _______________________________

Company Contact: ______________________________ Cell: _______________________________

Address: ______________________________ Email: _______________________________

City, Prov., P.C. ______________________________________________________________________

Describe your company and the business you do: _____________________________________________

_____________________________________________________________________________________

How did you find out about us? ___________________________________________________________

Sole Proprietor Partnership LLC Corporation

Corporation #:

Date established: _________ Years in present ownership:__________

2015 Annual Revenue: _____________ 2016 Annual Revenue: _____________

Amount of funding requested $ _____________________ Preferred loan type: ___________

(Examples of loan types: Business Term Loan, Line of Credit, Merchant Cash Advance, Invoice Factoring, Commercial Mortgage)

If you have chosen a Merchant Cash Advance, what is your average monthly summary total: $__________

What will the funds be used for: ___________________________________________________________

______________________________________________________________________________________

Principals of The Company:

Officer 1 Name: ___________________________________________________________________ Title: ___________________________________________________________________

SIN#: ___________________________________________________________________ Date of Birth: ___________________________________________________________________ Home Address: ___________________________________________________________________ Signing Authority: Yes_______ No _______ Percentage Owned: _____________________

Officer 2 Name: ___________________________________________________________________ Title: ___________________________________________________________________

SIN#: ___________________________________________________________________ Date of Birth: ___________________________________________________________________ Home Address: ___________________________________________________________________ Signing Authority: Yes_______ No _______ Percentage Owned: _____________________

Officer 3 Name: ___________________________________________________________________ Title: ___________________________________________________________________

SIN#: ___________________________________________________________________ Date of Birth: ___________________________________________________________________ Home Address: ___________________________________________________________________ Signing Authority: Yes_______ No _______ Percentage Owned: _____________________

please list ‘2’ Supplier References: (Companies who give you credit) If you do not receive credit from any company(s), leave blank

1. Name: _____________________________________________________________

Telephone Number: _____________________________________________________________

Business Name: _____________________________________________________________

Association with you: _____________________________________________________________

2. Name: _____________________________________________________________

Telephone Number: _____________________________________________________________

Business Name: _____________________________________________________________

Association with you: _____________________________________________________________

* Please Rate Your Credit For Us Between 1 & 10, with 1 being poor & 10 being excellent: ___________

Banking Information:

Name of Bank: Branch Address: _________________________

Chequing Acct #: Contact Person: _________________________

Are any company assets pledged as security?

Circle all that apply.: Accounts Inventory Equipment Invoices None

Bank Loans:_______________________________ Collateral: ___________________________________

Have you ever had any personal or corporate Litigation/Judgment? Yes ? No

(If Yes, please describe here) ______________________________________________________________

Have you ever been convicted or found guilty of an offense under any law or are any charges now pending?

If yes, please attach full particulars on a separate sheet signed and dated statement. ? Yes ? No

Have you ever gone insolvent? ? Yes ? No

The foregoing information is true and correct to the best of my knowledge and is given to induce Capital Credit Canada’s lending partners to consider entering into a financing agreement with this company. I hereby authorize Capital Credit Canada’s lending partners or their agents to verify and investigate any or all of the foregoing statements, including but not limited to my/our credit worthiness and financial responsibility. I/We grant Capital Credit Canada’s lending partners the right to procure any and all credit reports pertaining to any party listed in this application, including, but not limited to, all principals of the applicant company.

Agreed and consented to:

Signature: _____________________________ Print Name: ___________________________

Title: _____________________________ Date: ___________________________

Signature: _____________________________ Print Name: ___________________________

Title: _____________________________ Date: ___________________________

Signature: _____________________________ Print Name: ___________________________

Title: _____________________________ Date: ___________________________

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