ACFO Micro Loan Application

Loan Application Form

BUSINESS INFORMATION
Legally Incorporated Business Name *
Operating Name
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Email*
example@example.com
Business Phone *
Website
Facebook
LinkedIn
Other (Social Media)
Date Established*

MonthDayYear
Date
Current Ownership Since*

MonthDayYear
Date
Fiscal Year End Date *

MonthDayYear
Date
Industry*
Business Number (CRA number – 9 figures)*
Number of Current Full-Time Employees (including owners)*
Number of Full-Time Jobs Created (as a result of this loan)*
Number of Full-Time Jobs Maintained (as a result of this loan)*
Number of Current Part-Time Employees*
Number of Part-Time Jobs Maintained (as a result of this loan)*
Number of Current Part-Time Jobs Created (as a result of this loan)*
Has the owner(s) or the Business ever been party to a claim or lawsuit, currently owe any back taxes or declared bankruptcy?*

YESNO
If yes to the above, please provide details
Are the owner(s) or the Business an endorser, guarantor or co-signer for any other obligations?*

YESNO
If yes to the above, please provide details
Do the owner(s) own shares in any private company other than the entity that has applied to the ACCFutures?*

YESNO
If yes to the above, please provide details
Loan Purpose

Breakdown costs and where funding is coming from

Project Cost

	$ amount
Land/Building
Vehicles
Equipment
Inventory
Working Capital
TOTAL COST

Project Funding

	$ amount
Owner Investment
ACCFutures Loan Request
Other Lenders
Other Equity
TOTAL FUNDING

Number of Owners*
Equality and Diversity (choose all that apply)

Official Language Minority CommunityIndigenousPerson's with DisabilitiesLGBTQ2+Newcomer to CanadaVisible MinorityYouth (39 and under)Other

OWNER #1 PERSONAL INFORMATION
Name*

First NameLast Name
Middle name
Percentage (%) of Ownership in the Company*
Provide a copy of government issued photo identification (passport, driver's license)

Cancelof
Date of Birth *

MonthDayYear
Date
Alias (if known by another name now or previously)

First NameLast Name
E-mail Address*
example@example.com
SIN (optional)
Immigration Status*

Canadian CitizenPermanent ResidentOther
Marital Status

MarriedSingleCommon LawDivorcedSeparated
Spouse's Name (if applicable)

First NameLast Name
Number of Dependents
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RentOwnOther
Current Occupation*
Employer Name and Address*
Since*

MonthDayYear
Date
Annual Salary*
Spouse’s Occupation
Spouse’s Employer Name and Address
Since

MonthDayYear
Date
Spouse’s Annual Salary
Total Household Income*
Monthly mortgage or rent payment*
Annual Property Taxes*
Monthly Condo Fees
PERSONAL ASSETS AND LIABILITIES (including any held jointly with your spouse)

Cash in Personal Bank Accounts*
RRSPs / RESPs
Marketable Investments Stocks, Bonds, GICs, etc.
Total Balance owing on Personal Credit Card(s)*

OWNER #2 PERSONAL INFORMATION
Name*

First NameLast Name
Middle name
Percentage (%) of Ownership in the Company*
Provide a copy of government issued photo identification (passport, driver's license)

Cancelof
Date of Birth *

MonthDayYear
Date
Alias (if known by another name now or previously)

First NameLast Name
E-mail Address*
example@example.com
SIN (optional)
Immigration Status*

Canadian CitizenPermanent ResidentOther
Marital Status

MarriedSingleCommon LawDivorcedSeparated
Spouse's Name (if applicable)

First NameLast Name
Number of Dependents
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RentOwnOther
Current Occupation*
Employer Name and Address*
Since*

MonthDayYear
Date
Annual Salary*
Spouse’s Occupation
Spouse’s Employer Name and Address
Since

MonthDayYear
Date
Spouse’s Annual Salary
Total Household Income*
Monthly mortgage or rent payment*
Annual Property Taxes*
Monthly Condo Fees
PERSONAL ASSETS AND LIABILITIES (including any held jointly with your spouse)

Cash in Personal Bank Accounts*
RRSPs / RESPs
Marketable Investments Stocks, Bonds, GICs, etc.
Total Balance owing on Personal Credit Card(s)*

OWNER #3 PERSONAL INFORMATION
Name*

First NameLast Name
Middle name
Percentage (%) of Ownership in the Company*
Provide a copy of government issued photo identification (passport, driver's license)

Cancelof
Date of Birth *

MonthDayYear
Date
Alias (if known by another name now or previously)

First NameLast Name
E-mail Address*
example@example.com
SIN (optional)
Immigration Status*

Canadian CitizenPermanent ResidentOther
Marital Status

MarriedSingleCommon LawDivorcedSeparated
Spouse's Name (if applicable)

First NameLast Name
Number of Dependents
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RentOwnOther
Current Occupation*
Employer Name and Address*
Since*

MonthDayYear
Date
Annual Salary*
Spouse’s Occupation
Spouse’s Employer Name and Address
Since

MonthDayYear
Date
Spouse’s Annual Salary
Total Household Income*
Monthly mortgage or rent payment*
Annual Property Taxes*
Monthly Condo Fees
PERSONAL ASSETS AND LIABILITIES (including any held jointly with your spouse)

Cash in Personal Bank Accounts*
RRSPs / RESPs
Marketable Investments Stocks, Bonds, GICs, etc.
Total Balance owing on Personal Credit Card(s)*

OWNER #4 PERSONAL INFORMATION
Name*

First NameLast Name
Middle name
Percentage (%) of Ownership in the Company*
Provide a copy of government issued photo identification (passport, driver's license)

Cancelof
Date of Birth *

MonthDayYear
Date
Alias (if known by another name now or previously)

First NameLast Name
E-mail Address*
example@example.com
SIN (optional)
Immigration Status*

Canadian CitizenPermanent ResidentOther
Marital Status

MarriedSingleCommon LawDivorcedSeparated
Spouse's Name (if applicable)

First NameLast Name
Number of Dependents
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RentOwnOther
Current Occupation*
Employer Name and Address*
Since*

MonthDayYear
Date
Annual Salary*
Spouse’s Occupation
Spouse’s Employer Name and Address
Since

MonthDayYear
Date
Spouse’s Annual Salary
Total Household Income*
Monthly mortgage or rent payment*
Annual Property Taxes*
Monthly Condo Fees
PERSONAL ASSETS AND LIABILITIES (including any held jointly with your spouse)

Cash in Personal Bank Accounts*
RRSPs / RESPs
Marketable Investments Stocks, Bonds, GICs, etc.
Total Balance owing on Personal Credit Card(s)*

OWNER #5 PERSONAL INFORMATION
Name*

First NameLast Name
Middle name
Percentage (%) of Ownership in the Company*
Provide a copy of government issued photo identification (passport, driver's license)

Cancelof
Date of Birth *

MonthDayYear
Date
Alias (if known by another name now or previously)

First NameLast Name
E-mail Address*
example@example.com
SIN (optional)
Immigration Status*

Canadian CitizenPermanent ResidentOther
Marital Status

MarriedSingleCommon LawDivorcedSeparated
Spouse's Name (if applicable)

First NameLast Name
Number of Dependents
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RentOwnOther
Current Occupation*
Employer Name and Address*
Since*

MonthDayYear
Date
Annual Salary*
Spouse’s Occupation
Spouse’s Employer Name and Address
Since

MonthDayYear
Date
Spouse’s Annual Salary
Total Household Income*
Monthly mortgage or rent payment*
Annual Property Taxes*
Monthly Condo Fees
PERSONAL ASSETS AND LIABILITIES (including any held jointly with your spouse)

Cash in Personal Bank Accounts*
RRSPs / RESPs
Marketable Investments Stocks, Bonds, GICs, etc.
Total Balance owing on Personal Credit Card(s)*

Should be Empty:

	Address	Market Value	Registered Owner(s)	Debt Holder(s)	Balance Owing	Type (rental unit, cottage, etc)	Annual Rental Revenue (if applicable)
Personal Residence
Other
Other
Other
Other
Other

	Type (bank loans, lease, car loans, line of credit, etc.)	Creditor	Monthly payment (principal & interest)	Collateral given as security for the loan	Balance Owing
Liability 1
Liability 2
Liability 3
Liability 4
Liability 5
Liability 6

	Address	Market Value	Registered Owner(s)	Debt Holder(s)	Balance Owing	Type (rental unit, cottage, etc)	Annual Rental Revenue (if applicable)
Personal Residence
Other
Other
Other
Other
Other

	Type (bank loans, lease, car loans, line of credit, etc.)	Creditor	Monthly payment (principal & interest)	Collateral given as security for the loan	Balance Owing
Liability 1
Liability 2
Liability 3
Liability 4
Liability 5
Liability 6

	Address	Market Value	Registered Owner(s)	Debt Holder(s)	Balance Owing	Type (rental unit, cottage, etc)	Annual Rental Revenue (if applicable)
Personal Residence
Other
Other
Other
Other
Other

Loan Application Form

Loan Purpose