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1.General

2.Legal

3.Bank

4.Accounts Receivable

5.Background

6.Owner/Officer

7.Supporting Docs

8.Authorization

General Business Information

Please Enter Legal Name of your Business
Please Enter Trade Name
Primary Business Address
Please Enter Your Address Line 1
Please Enter Your Address Line 2
Please enter your Postcode.
Please enter your City.
Please enter your State.
Please enter your Country.
Mailing Address
Address Line 1
Address Line 2
Please enter your Postcode.
Please enter your City.
Please enter your State.
Contact Details
Please Enter Telephone Number
Please Enter Fax Number
Please Enter Cell Number
Please Enter Email Address

Legal Form of Business

Please Select Province of you corporation.
Please Enter Years in Business
Please Enter D&B Number
Type Of Business(Describe Product or Service)

Bank Information

Please Enter Your Bank Name
Please Enter Your Full Bank Address
Please Enter Bank Phone Number
Please Enter Bank Chequing Account Number
Please Enter Bank Saving Account Number
Please Enter Bank Loan Number

Accountant

Please Enter Bank Accountant Name
Please Enter Bank Accountant Phone Number
Please Enter Bank Accountant E-Mail

Lawyer

Please Enter Bank Lawyer Name
Please Enter Bank Lawyer Phone Number
Please Enter Bank Lawyer Bank Lawyer E-Mail
Please Enter Referred By

Accountants Receivable Information (Please Supply A/R Aging and Customer Names and Addresses)

Please Enter Total Receivable Outstanding In Dollars.
Please Enter Average Monthly Sales In Dollars.
Please Enter Average Invoice Value In Dollars.
Please Enter Average Number of Invoices Per Month.
Please Enter Average of Financing Requested In Dollars.
Please Enter Total Number Of Customers.
Please Enter Average Number Of days To Collect.
Please Enter Write-Off Percentage.
Please Enter Terms Of Sales
Purpose Of Loan/Use Of Funds
Number of Trucks

Background Information

Owner(s)/Officer Information

Please Enter Owner First Name
Please Enter Owner Last Name
Please Enter Your Address Line 1
Please Enter Your Address Line 2
Please Enter Your City.
Please select your Province.
Please select your Country.
Please enter your Postcode.
Please enter your Social Insurance Number.
Please enter your Driver's Licence.
Please enter your Date Of Birth.
Please enter your Position.
Please enter your Ownership Percentage.
Please enter your Phone.
Remove this Owners:
Add More Owners:

Supporting Documentation

Please include the following documents with your application in JPG,JPEG or PDF format

Documents Checklist

Authorization To Release Information *

The information supplied in this Confidential Financing Application, Company Profile form, and all forms and documents submitted (collectively the “Application”) to BVD Capital Corp., its subsidiaries or its Assignee (Collectively “Funder”) in connection herewith is true and correct to the best of my/our knowledge and belief. I/We hereby authorize Funder to investigate my/our financial responsibility and credit worthiness and will provide financial statements, tax returns, or other materials or information as requested by Funder and to verify an information provided from any source Funder may choose. I/We grant Funder the right to procure any and all credit or other investigate reports to any party to this application. I/We grant Funder the right to release any of the information contained herein or any results from any investigation of the information contained herein to a third party that may become part of any financing transaction between applicants and Funder or to whom Funder may refer this applicant to for funding. I/We further grant to any sources from which Funder has requested information about applicant(s), the authorization to release such information to Funder. Applicant acknowledges that Funder will rely on the information provided herein to make its credit decision regarding Applicant. This Application has been completed and signed under penalty or perjury. A photocopy, including a fax copy m of this authorization may be accepted as an original.

User Profile 12 messages

James Jones
Application Developer
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