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A business finance consultant will use this information to identify a strategy for funding. All information you provide will be kept strictly confidential, forwarded only when a perspective lender is identified.

* Denotes Required field

    Applicant Name*:

    Title:

    Company Name*:

    Street Address*:

    City*:

    Province / State*:

    Country*:

    Postal Code / Zip*:

    Telephone*:

    Cellular Phone:

    Fax:

    E-mail*:

    Start Up or Existing Business:

    Start UpExisting Business

    Years in Business:

    Ownership:

    Sole ProprietorshipPartnershipCorporation

    Industry:

    Amount of Financing Requested $:

    Equity Invested by Client $:

    Purpose of Financing:

    MortgageWorking CapitalFranchise PurchaseEquipment FinancingReceivables FinancingOther

    Briefly Describe Purpose of Financing:

    Business Plan Available:

    YesNo

    Personal Guarantee Available:

    YesNo

    Credit History of Owner:

    ExcellentSatisfactoryPoor

    Credit History of Company:

    ExcellentSatisfactoryPoor

    If Business Purchase:

    Purchase Price $:

    If an Existing Business:

    Total Business Assets $:

    Total Business Liabilities $:

    Total Business Net Worth $:

    Company’s Annual Revenue $:

    Company’s Annual Net Profit $:

     

    Casb Management Group Inc.

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