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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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