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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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