Application for Business Financing and Equipment Leasing

By clicking on the "SUBMIT Query" Button at the bottom of the application, I accept, authorize and request that  Advanced Commercial Credit International (ACI) Limited, and/or it's assigns, to release to, and obtain from, credit reporting agencies, assigns, and other third parties, any and all credit, personal and business information, regarding the information contained in this application, and for information gathered not included in this application, and this authorization also includes credit checks.

When finished, after you click on the "SUBMIT Query" Button at the bottom of the page, a representative from ACI will contact you.

PART 1: PERSONAL STATEMENT OF AFFAIRS

Advanced Commercial Credit International (ACI) Limited

_______________________________________

181 Cavalier, Lower Sackville, Nova Scotia, Canada, B4C 3L1

Telephone: (902) 468-1981

Toll Free: (888) 755-8355

Fax: (902) 484-7081

First Name

Last Name

Email Address

Home Address

City

State/Province

Zip/Postal Code

Country

Home Telephone Number

Home Fax Number (Or Other Fax Contact Number)

Date of Birth

SSN / SIN Number

Marital Status

Number of Dependants (Excluding Spouse)

Employer

Since What Month and Year

Can We Confirm Your Employment?

Employer Telephone Number

Bank Name

Bank Address

How Long (Years)

Bank Telephone Number

Your Gross Monthly Income

Spouse/Other Monthly Income

Average Monthly Chequing Balance

Average Monthly Savings Balance

Cash in Chequing Accounts

Cash in Savings Accounts

GIC's and Term Deposits

Notes/Amounts Due to You From Others

Life Insurance (Cash Value)

Stocks and Bonds

Real Estate - Market Value

Vehicles - Market Value

Value of Retirement Plans

Other Assets

Mortgages Owed

Mortgage Monthly Payment

Credit Cards Total Owed

Credit Card Monthly Payments

Total Bank Loans

Total Bank Loans Monthly Payments

Other Credit Facilities Total Owed

Total Other Credit Facilities Monthly Payments

Total Taxes Owed

Have you Guaranteed Any One Else's Debts? (Provide Details)

Have You Ever Declared Personal Bankruptcy? If Yes When? (Provide Details)

Are There Any Legal Judgments Against You or Legal Suits Pending or On-Going?( If Yes, Provide Details)

PART 2: BUSINESS APPLICATION

Your Business Name

Type of Business

Business Address

City

State/Province

Zip/Postal

Business Telephone Number

Business Fax Number

Date Business Established

Federal Business Tax Number

Average Business Cash Balances

Principal 1 Name

Principal 1 Address

Principal 1 City

Principal 1 State/Province

Principal 1 Zip/Postal Code

Principal 1 SSN/SIN

Principal 2 Name

Principal 2 Address

Principal 2 City

Principal 2 State/Province

Principal 2 ZIP/Postal Code

Principal 2 SSN/SIN

Business Bank Name

Business Bank Address

Length of Time With Current Bank (Years)

Business Bank Account Number

Business Bank Telephone Number

Business Bank Contact Person

Trade Reference 1 Name

Trade Reference 1 City

Trade Reference 1 State/Province

Trade Reference 1 Account #

Trade Reference 1 Telephone Number

Trade Reference 1 Contact Name

Trade Reference 2 Name

Trade Reference 2 City

Trade Reference 2 State/Province

Trade Reference 2 Account #

Trade 2 Reference Telephone Number

Trade 2 Reference Contact Name

Trade 2 Reference Telephone Number

Can We Do A Personal Credit Check On You?

Can We Discuss Your Personal and Business Affairs With Potential Lenders?

Please Describe Your Financing Request.

Total Value Of Business Assets From Financial Statements

Total Business Liabilities From Financial Statements

Total Retained Earnings