Short Term Finance Loan Application Form Introducer Company Name Contact Details
Business Telelphone
Business Fax
Email
Applicant 1
Applicant 2
Surname
Surname
Given Name/s Mr, Mrs, Ms, Miss, Other
Given Name/s Mr, Mrs, Ms, Miss, Other
Age DOB
Age DOB
SIN
SIN
Drivers Licence Number
Drivers Licence Number
No. of Dependents
Ages
No. of Dependents
Ages
Contact Details
Contact Details
Home Work
Home Work
Mobile
Mobile
Email
Email
Residential Address
Residential Address
Postal Code
Previous Address
Previous Address
Postal Code
Employment Details
Employment Details
Company Name
Company Name
Address
Address
Postal Code
Postal Code
Position
Position
Annual Income
Annual Income
Years Employed
Years Employed
1
Postal Code
Postal Code
Borrower Details—Company (if applicable) Business Structure
Company
Name of Directors Partnership
Sole Trader Trust
Business Name/Trust
Date Established Name of Shareholders BN/ACN:
Correspondence Address
Postal Code
No. of Employees
Registered Office Address
What is the nature of the business?
Postal Code
Statement of Assets & Liabilities (if this section is insufficient please submit a more detailed statement) Assets
Liabilities
Cash:
$
Bank Loans:
$
Savings:
$
Credit Cards:
$
RRSPs:
$
Automobile Loans:
$
Investments:
$
Mortgage Loans:
$
Real Estate:
$
Finance Company:
$
Automobile:
$
Alimony/Child Support:
$
Other Assets:
$
Other Debts:
$
Total:
$
Total:
$
2
Security Offered 1
Security Offered 2 Property Address
Property Address
Postal Code
Type of Property
Type of Property
Postal Code
Vacant Land
Commercial
Estimated Market Value
Residential
Vacant Land
Commercial
Estimated Market Value
$
Existing Lender
Existing Lender
Bank $
Bank $
Amount Owing
Amount Owing
$
$
$
Details of Arrears $
Details of Arrears $
Account Details
Account Details
Account 1
Account 1
Amount $
Amount $
Account 2
Account 2
Amount $
Amount $
Land Description (as appears on tax bill)
Land Description (as appears on tax bill)
Assessment No.
Assessment No.
Solicitor Details
Accountant Details (if applicable)
Name
Name
Firm
Firm
Office Address
Office Address
Postal Code
Phone
Phone
Email
Email
3
Postal Code
Residential
Loan Purpose & Exit Strategy (This section must be filled out in detail for your loan to proceed) Amount Required $
Loan Term
Loan Purpose (This section must be completed in order to properly process your loan.)
Exit Strategy (Please provide in detail the proposed method(s) of how this loan is to be repaid. Supporting information to be attached.)
I/we declare that the above information is true and correct in every particular and it is upon the basis that I/We make this application.
Name (Applicant 1)______________________________________
Name (Applicant 2)__________________________________
Signature ________________________________________________ Signature _____________________________________________ Date ____________________________________________________ Date_________________________________________________
Name (Applicant 3)______________________________________
Name (Applicant 4)__________________________________
Signature ________________________________________________ Signature _____________________________________________ Date ____________________________________________________ Date_________________________________________________ 4
Providers of Short Term Finance Options T 902-499-2979 E
[email protected] W www.alternativefinancingoptions.ca
86 Snowy Owl Drive Bedford, Nova Scotia B4A 3L3
Privacy Agreement for Alternative Financing Options This document describes how Alternative Financing Options manages personal information. 1. Collecting personal information about you The kind of personal information we hold. We only collect personal information that is necessary for us to perform our functions and activities which consist of the origination and administration of loans and related activities. The kinds of personal information we collect and hold will depend upon your dealings with us and the circumstances in which it was collected, but may include: • Information you provide to us when you apply for a loan or when you offer to guarantee a loan such as name, address and contact details. • Financial information about you such as your current asset & liability status. • Information about any existing loans provided to you such as current balance, loan limit, security offered, details of arrears. 2. Using and disclosing your personal information The purposes for which we collect and hold personal information and how we use and disclose it. We respect your privacy. Any personal information which we collect about you will be used by us to assess your application for a loan and to facilitate provision and administration of loans and related activities. In order to do this, we may disclose your personal information to: • Professional advisers such as solicitors, accountants and appraisers • Government agencies such as those which administer land titles • Credit providers such as those that hold a priority mortgage • Other organizations which participate in funding, providing and administering your loan or the loan you have guaranteed. • Credit reporting agencies. 3. Security of Personal Information Where we no longer require any personal information for the purpose it was collected, we will take reasonable steps to destroy that information by secure means or to permanently de-identify the personal information from the individual. 4. Access to your personal information In most cases, you can gain access to personal information that we hold about you. If you wish to do so, please address Peter Ryan, AFO’s Director: Alternative Financing Options, 86 Snowy Owl Drive, Bedford, Nova Scotia B4A 3L3,
[email protected].
5
ACKNOWLEDGEMENT BY THE APPLICANT ABOUT THE COLLECTION, RECORDING USE AND DISCLOSURE OF PERSONAL INFORMATION BY THE APPROACHED CREDIT PROVIDER. 1. Agreement that Alternative Financing Options may seek consumer credit information If Alternative Financing Options considers it relevant to assessing my/our application for short term financing, I/we agree to Alternative Financing Options obtaining from a credit reporting agency a credit report containing personal credit information about me/us in relation to short term financing provided by Alternative Financing Options. 2. Exchanging information with other credit providers I/we agree to Alternative Financing Options obtaining personal information about me/us from other credit providers, whose names I/we may have provided for Alternative Financing Options or that may be named in a credit report, for the purpose of assessing my/our application for short term financing made to Alternative Financing Options. 3. Agreement to a credit provider being given a consumer credit report to collect overdue payments on short term loans I/we agree that Alternative Financing Options may obtain a consumer credit report about me/us from a credit reporting agency for the purpose of collecting overdue payments relating to a short term loan owed by me/us.
Applicant’s Name
Applicant’s Name
Applicant’s Signature
Applicant’s Signature
Date Date
6
Environmental Questionnaire ProPerty Address Borrower(s)
(a) Are you aware of any radon gas problems?
(b) Are you aware of any hazardous material being stored on the property?
(c) Are there any underground oil tanks?
(d) Are you aware of any environmental problems or soil contamination of any kind on this property or in this immediate area, such as toxic waste, gasoline, fuel tanks, mould asbestos, etc.?
If yes, please provide an Environmental Report and Certificate of Compliance.
Date:
___________________________________________________
Borrower: Signature __________________________________________ Print ____________________________________________ Borrower: Signature __________________________________________ Print ____________________________________________ Witness: Signature __________________________________________ Print ____________________________________________ 7
