Project Information Project Name: Legal Address: City: State: Select Your State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming N/A Zip: Applicant Information Applicant Name: Email Address: Mailing Address: City: State: Select Your State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming N/A Zip: Telephone: Fax: Request Amount: Equity in Project: Collateral: Appraised Value: Loan Balance: Project Description: Proposed terms/conditions & projections Type of Financing: Please choose one Debt (Loan) Combination (Debt/Loan) Equity (Investor Investment) IPO Interest Rate (Preferred): Terms of Loan (Preferred): Lender Points: Lender's Equity: Year (1) One | Year (2) Two Projected Sales: Projected Expenses & Cost of Sales: Projected Gross Profit: Miscellaneous Information Years in Business: Please Choose One Start-Up 1 to 3 Yrs. 4 to 7 Yrs. 8 to 10 Yrs. Over 10 Yrs. Use of funds: Please Choose One Acquisition Construction Equipment Refinance Research & Development Working Capital Real Estate Inventory Furniture/Fixtures Miscellaneous Applicant's Net Worth: Please Choose One Personal Corporation Combination Applicant's Liquid Assets: Please Choose One Personal Corporation Combination