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Inventory
Contact
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Finance
Applicant’s Personal Information
Name
*
Birth Date(M/D/Y)
Sin
Address
City
State/Province
ZIP / Postal Code
How Long
Own Monthly Payment
Rent
Home Phone Number
Best time to contact
Email Address
*
Any prior repossession?
Yes
No
Any legal suits?
Yes
No
Have you ever declared bankruptcy?
Yes
No
Transaction Details- Equipment Information
Make
Model
Year
Attachments
New
Used
$ Canadian
$ US
Lease
Loan
Sale price
Reason
Additional
Replacement / If replacing, what is being replaced?
What is the effect on the business? (Please explain.)
General Corporate Information
Full Legal Business Name (Including “Operating AS”)
Proprietorship
Corporation
Other
Partnership
Corporate Address
City
State/Province
ZIP / Postal Code
Phone Number
Fax Number
Website
Financial Year End
Top 3 Clients
Client Name
Percentage of Business
Total Years in Business
Number of Employees
Fleet Size:
Number of Trucks:
Number of Trailers:
Shareholder Contact Name
Shareholder Contact Name
Ownership %
Personal Net Worth
Assets
Values
Residence
Residence Value
Cash on Hand
Cash on Hand Value
Personal Vehicles
Personal Vehicles Value
Investments/RRSP
Investments/RRSP Value
Other Assets
Other Assets Value
Total Assets
Total Assets Value
Liabilities
Value
Mortgage
Mortgage Value
Loans
Loans Value
Credit Card(s)
Credit Card(s) Value
Other Liabilities
Other Liabilities Value
Total Liabilities
$
(Total Assets- Total Liabilities) NET WORTH
$
Business/Personal References
Business/Personal References
Reference Name
Relationship
Street Address
Telephone
Submit
Address: 5307 72A Ave NW, Edmonton, AB T6B 2J1, Canada
Phone: +1 780-290-7979
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