Clone of Demande de financement

Financing Application

This data will only be accessible forthe analysis of your application and the preparation of anonymized analyses,which will be treated confidentially.
Type of Financing
Amount Requested :
Documents to Provide with the Application
Business Identification
Business Name :
Head Office Address

Number and street

Complément d'adresse

CityÉtat/Région

Postal Code
Address of Principal Establishment: (if different from head office)
Website :
Principal Entrepreneur Identification
Gender Identity
Your Name

First NameLast Name
Title :
Phone Number
Format: (000) 000-0000.
Email :
exemple@exemple.com
Year of Birth :
Status at Time of Application :
Education Completed
Contact Person Identification

(If different from the entrepreneur)
Gender Identity
Name :

First NameLast Name
Title :
Phone Number :
Format: (000) 000-0000.
Year if Birth :

Shareholding

Rows	Name	Address	% Voting Shares	Number of Shares	Share Category	Title/Rlationship to Business	Gross Annual Salary
1
2
3
4

Sales Information

Rows	In Québec	In Canada	Export
% Sales

Line of Credit

Rows	Authorized	Available	Interest Rate
Amount

Declaration and Consent
I declare that all information provided is accurate.
I consent to the use/disclosure of my contact information, information regarding my entrepreneurial activities, and attached documents for the analysis of my application or for reporting, monitoring, and evaluation purposes by the CAE.

I declare that I have not added or concealed any information that could influence the decision. I understand that my personal data will be used for anonymized statistical analyses.

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Financing Application