Business Loan Application

South Lake Community Futures Development Corporation183 The Queensway South, Keswick, ON, L4P 2A3

Phone: 905-476‐1244 Email: tross@southlakefutures.ca

www.southlakefutures.ca

IFC-001-2

Loan Application ChecklistPlease check that all the necessary information has been included with this application. Applications that are incomplete or missing information will not be reviewed.

# New Business

Existing Business

Attachment

1 Business Loan Application. (typed applications only)2 Statement of Personal Assets & Liabilities for each

owner/partner/guarantor.3 Business Plan.4 Cash Flow Forecast‐ sales and expenses by month for two years

(include startup costs for new businesses). This should show the impact of the loan and the loan being repaid.

5 Business License or Articles of Incorporation.6 N/A Statement of Account of latest Canada Revenue Agency Source

Deduction form (RP).7 N/A Statement of Account of latest Canada Revenue Agency HST Form

(RT).8 N/A Revenue Canada Notice of Assessment (T2) for Corporations.

9 N/A Revenue Canada Notice of Assessment (T2) for Individuals.10

List of Major Equipment and Inventory Owned.

11

Current Internal Financial Statements.

12

N/A Financial Statements of Previous Year End(s) and/or personal tax return for Sole Proprietorships. Past two years, if available.

13

Details of Any Business Debt Obligations Pledged to Lenders and Security/Collateral.

14

Partnership Agreement – if applicable.

15

Details of Lease Agreement – if applicable.

16

A Copy of Your Driver’s License or Other Identification.

Return the completed Business Loan Application and applicable attachments to The Business Loans Officer, Tom Ross, at tross@southlakefutures.ca.

Application Review Process:1. Completed applications will be reviewed by our Investment Fund Committee.2. Applications that are recommended for approval will be reviewed by our board of directors.3. Following the board meeting, you will be notified of the board of directors’ decision.

If there is any part of the application or process that you do not understand or need more information about, do not hesitate to contact South Lake Futures at (905) 476-1244.

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Business InformationYour business plan should address the questions in this section. If you are missing any of them in your business plan, you must answer them here.

Business Name and NumbersLegal NameOperating NameCorporation NumberCRA Business Number

Ownership InformationName(s) of Owner(s) % Ownership

123

Business Contact InformationBusiness AddressMailing Address (If different)Telephone 1Telephone 2EmailWebsite

Business InformationBusiness Established (MM/YYYY or new)Fiscal Year End Date (MM/YYYY)Industry Business Operates inBusiness Type

Loan InformationPurpose of the loanAmount Requested Repayment Term (in years)Loan Security (Collateral)

Note: The ideal security is real estate. Security can be owned by the business or can be personal assets. Include their fair market value.

Job Creation InformationNumber of full-time jobs being createdNumber of full-time jobs that will be maintained as a result of the loanCurrent number of full-time employees including yourself

Note: A full time job is 35-40 hours per week. 20-30 hours per week is equivalent to 0.5 full time jobs, and less than 20 or seasonal is considered 0.25.

Does your business meet government regulations and license requirements?How did you hear about us?

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Professional Service ProvidersAccountantLawyerInsurance Provider

Outstanding Business LoansLoan #1Lender Purpose Interest RateContact Name Contact

Phone/EmailPayment

Original Balance

Outstanding Balance

Date Advanced

Maturity Date AddressSecurity or Collateral

Comments

Loan # 2Lender Purpose Interest RateContact Name Contact

Phone/EmailPayment

Original Balance

Outstanding Balance

Date Advanced

Maturity Date AddressSecurity or Collateral

Comments

Have all required Government Remittances (GST/HST, Employer Source Deductions) been paid in accordance with your remittance schedule (yes or no)? _________

If there are remittances owing to the Government, please complete the table below.Owing To Amount Details

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Business Plan

This section is to be completed if you do not have a business plan.

Classification of BusinessRetail FoodConstruction TourismManufacturing ServiceWholesale OtherWill your involvement in the business be: Full-time Part-timeIf part-time, please explain how your business will be able to operate full-time.

ObjectivesDescribe in detail what your business will do. What product or service will be provided?

Competition and SuppliersWho are your competitors, what are their locations and how long have they been in business?

Explain why your customers will prefer your product or service over your competitors.

Who are your major suppliers (if applicable), where are they located and what are their credit terms? Can you change your suppliers easily if required?

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CustomersWhat market research have you conducted to determine how many potential customers are in the area you plan to operate in? Please provide details of research and the results (i.e. surveys, statistical data, etc.).

What are the demographics of your typical customers?

How will you inform your customers about your service or product?

What form of advertising would be most effective for your business (i.e. business cards, radio, newspaper, pamphlets, social media, etc.)?

How much do you intend to spend on advertising? Have you budgeted for this expense?

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Price and CostWhat is the cost for you to offer your product(s) or service(s) to your customers? Costs may be expressed per unit, hour, or job. Provide a breakdown of how you determined your costs including materials, labour, inventory, and overhead costs.

What price will you charge your customers for product(s) or service(s)? Provide a breakdown of how you arrived at your prices (include your costs and markup or profit margins). How does your price compare to the competition?

What level of sales would you have to reach in order to just cover your expenses (break-even point)?

Have you made provision for contingency costs in your pricing (i.e. warranty, servicing, etc.)?

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Operating RequirementsWhat government regulations, licenses, permits and insurance pertain to your business and have they been obtained?

Identify your business requirements such as size and type of premises, equipment, furniture and fixtures. Will they be leased or purchased? Will deposits be required?

What skills and or knowledge are you bringing to the business? What other skills are required to operate your business and who will provide them?

How many employees will you have to hire?

Number of employees at start-up: ____ Part-time ____ Full-timeNumber of employees by year 3: ____ Part-time ____ Full-timeWill franchises, patents, trademarks and licensing agreements be important factors in your business? Explain, including financial details.

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FinancialsItemize major expenditures to show total start-up costs including funds required for day-to-day operation (working capital).

Item Cost

Total Start-up Cost: $

What is the source of your cash contribution (i.e. savings, borrowed)? $

What is the amount of the loan you are applying for? $

Other sources of funding: $

Total Funds: $

Have you ever been self-employed?

If the new business fails, how would you repay the loan?

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Statement of Personal Assets and Liabilities (To be completed for each shareholder, partner, and guarantor)

Full NameDate of Birth (YYYY/MM/DD)SIN (Optional)Relationship to Applicant (Spouse/Shareholder/Guarantor)Address (Street and Number, City, Postal Code)Do you own or rent your home? Home PhoneCell Phone Work PhoneMarital Status (Married/Single/Separated/Divorced):EmployerPositionYears at EmployerAnnual Salary/WageOther Income SourceOther Income AmountSpouses Income (if applicable) Bank(s) or Credit Union (Name and Address)

Real Estate OwnedAddress 1 Fair Market Value Original Purchase PriceOutstanding Mortgages Original Purchase DateAddress 2Fair Market Value Original Purchase PriceOutstanding Mortgages Original Purchase Date

Statement of Net WorthAssets (Bank, personal and business assets, investments, Invested in Business)

Liabilities (Loans, mortgages, rent, outstanding credit card balances, lines of credit)

Item Value Item Value Monthly Payment

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Total $ $ $Disclosure and Release StatementTo: SOUTH LAKE COMMUNITY FUTURES DEVELOPMENT CORPORATION (the "Corporation")

1. I, hereby certify that the information in this Statement of Personal Assets and Liabilities is a complete and true declaration. The property values shown above are the fair market values of the properties and the amount of debts is the total potential indebtedness (inclusive of any other loans, credit cards, or other debts for which I have signed as a guarantor).

2. I confirm that if any statement I have made herein or in accompanying materials proves to be incorrect in any way, I shall notify the Corporation immediately.

3. I authorize the Corporation to obtain personal credit information about me from any source. By executing this statement, I acknowledge as notice in writing, the Corporation's intent to obtain this information and I authorize each source to provide this information to the Corporation.

4. I understand and agree that in order to perform a credit investigation, I need not provide my Social Insurance Number ("SIN") if I can provide alternative identification that is acceptable to the credit reporting agencies. If I do provide my SIN, I consent to the Corporation using this information for the limited purpose of performing a credit investigation.

5. I authorize the Corporation to retain this Statement of Personal Assets and Liabilities and any financial records, credit and reference reports for the Corporation's records and reporting to Industry Canada who oversees the Community Futures Program.

6. I confirm receipt of the Corporation’s Privacy Statement and understand and consent to the Corporation collecting, using, retaining and disclosing the information contained in this Statement of Assets and Liabilities for the limited purpose of determining my eligibility for financing as is required by law, and by Industry Canada. I understand that the Corporation will handle my personal information in strict confidence in accordance with Federal privacy law as set out in the Corporation’s Privacy Policy. If I have any questions or concerns about the management of my information, I may refer to the Privacy Policy, available at www.southlakecfdc.org or contact the Chief Privacy Officer.

Yes or No I am currently the subject of litigation before a court, tribunal, government board or agency, or

there is a threat of such litigation. There are unexecuted judgment(s) registered against me, such as: __________________________________________________________________

I have made an assignment or have been petitioned into bankruptcy; there are writs registered against my name. If yes, provide details: _________________________________________________________________

I certify that I am a Canadian Citizen or Landed Immigrant. Have you ever had an asset re-possessed? Do you owe any property taxes (as applicable) or personal income tax for prior years? If yes,

provide details: _______________________________________________________________________

Have you ever been the Principal or Guarantor of a business that filed for bankruptcy?

DATED AT_________________________________ THIS________ DAY OF, 20___

_________________________ ____________________________Witness Signature Applicant Signature

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Cash Flow ProjectionsThe Cash Flow Projection Template can be found on our website.

Terms of ReferenceEstimated Sales – The dollar amount of product/service you expect to sell.

Cash Receipts – Money you get from various sources.

Cash from sales – Money received from selling your product/service. If you provide credit, then money to be collected depends on collection policy and should be allocated to Accounts Receivable when collected.

Other (specify) – Money from sources not specifically identified on the cash flow forecast.

Cash Equity Contribution – Money the owner invests in business.

Cash Disbursements – Money the business pays out.

Purchase of Equipment – Money you spend on equipment purchases.

Rental Expenses – Money you pay for equipment/premises rental.

Benefits – Money you pay for employer’s portion of Canada Pension Plan, Unemployment Insurance, Employee Health Tax, Worker’s Compensation, etc.

Personal Drawings – Money you pay yourself to cover personal expenses.

Utilities & Telephone – Money you pay for utilities and telephone expenses.

Accounting & Legal – Money you pay for accounting, bookkeeping and legal services.

Cost of Goods/Services Sold – Money you pay for required licenses and insurance premiums.

Advertising/Promotion – Money you pay for advertising/promoting your product/service.

Selling Expenses – Money you pay for the selling of your product/service.

Office Expenses – Money you pay for office supplies and help.

Other (specify) – Money you pay for expenses not specifically identified (i.e. repairs, maintenance, etc.).

Loan Repayment – Money you repay the financial institution for its loan.

Monthly Surplus – The monthly cash receipts are greater than the month’s cash disbursements.

Monthly Deficit – The month’s cash receipts are less than the month’s cash disbursements.

Cumulative (to date) – Total of each and every month’s surplus and/or deficit.

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Disclosure and Release Statement

Application FeesAll applications are subject to an application fee of 0.5% of the total value of the loan, with a minimum of $100. Additional fees will be outlined in the Offer of Finance agreement.

THE APPLICANT UNDERSTANDS AND AGREES THAT:1. The Applicant will notify the CFDC immediately of any application pending and under

consideration by another lender, or if negotiations are entered, or an offer of financing is received during the period of the CFDC’s consideration of this application.

2. The applicant is responsible for payment of all charges relative to the preparation, execution and registration of documents that may be required by the CFDC or its solicitors.

3. The terms and conditions of any financing which may be authorized will be set forth in a Letter of Offer, for agreement and acceptance by the Applicant.

4. The statements made herein are for the express purpose of obtaining financing from the CFDC and are, to the best of the Applicant's knowledge and belief, true and correct. The Applicant understands that additional information in support of this application must be supplied to the CFDC, if requested, before adequate consideration can be given to this application. The Applicant realizes that any present or future indebtedness of the Applicant, or the Applicant's business, to the CFDC may become due and payable if any information provided by the Applicant to the CFDC proves to be inaccurate or incomplete.

5. In applying for this financing and, in the event that the CFDC approves such application, the Applicant's personal and confidential business information will be requested from the Applicant and/or collected from third parties that have information about the Applicant’s business and personal financial status for the purposes of determining the Applicant's eligibility for financing and reporting to the Federal Economic Development Agency for Southern Ontario (FedDev Ontario).

DISCLOSURE, RELEASE, AND WAIVER OF LIABILITY1. The Applicant acknowledges that he or she approached the CFDC to obtain information about

business and has or is preparing a business plan.2. The Applicant acknowledges that he or she is solely responsible for the success or failure of

his/her business, and that any information which is provided to the Applicant by representatives of the CFDC is for the Applicant’s understanding only. It is the Applicant's responsibility to verify the accuracy of such information or to seek additional information concerning any aspects of the Applicant's proposed business.

3. The Applicant further agrees to hold the CFDC, its employees, volunteers, representatives, and agents harmless and herby releases and discharges the CFDC from any actions, damages, claims or demands which may arise, directly or indirectly, as a result of any act or omission by the CFDC in providing information to the Applicant, and to indemnify the CFDC from any such actions, damages, claims or demands which might be suffered by the Applicant's business or any guarantor in connection with any such information, the Applicant’s participation in any and all of the CFDC’s services, or non‐compliance with Federal and Provincial laws and regulations.

4. The Applicant acknowledges that he or she is solely responsible for the hiring, employment, dismissal and all related matters with respect to persons employed as well as contractual arrangements with individuals or firms.

5. The Applicant acknowledges that he or she is responsible for payment of all legal fees, property appraisals, and other costs or expenses incurred in connection with this application and, in the event that the CFDC approves funding, the completion of the transaction.

Environment DeclarationPage | 12

The Applicant and, if applicable, the Guarantor(s):1. Are operating their business in conformity with all environmental legislation.2. Confirm that their assets, including real estate, comply with all environmental legislation.3. Have not used their assets in violation of environmental laws and no proceedings are underway,

nor have any notice(s) been received concerning any alleged violation(s) of environmental laws.4. Have not given a waiver concerning any compliance and/or violation of environmental laws to

the prior owners of their assets.5. Warrants that any environmental issues or concerns as known to the Applicant and/or the

Guarantor(s) have been disclosed to the CFDC, and that activities, as required, are in compliance with all applicable legislation, including the Canadian Environmental Assessment Act and the Canadian Environmental Protection Act.

Collection, Use, and Disclosure of Personal and Business Information1. The Applicant acknowledges that, as the operation of the CFDC is financially supported by the

Government of Canada, representatives of the Federal Economic Development Agency for Southern Ontario (Fed Dev Ontario) are permitted access to the files of the CFDC for monitoring and evaluation purposes and that the Applicant may be contacted by representatives of Fed Dev Ontario, such information as is acquired by the Ministry will be treated as confidential.

2. The Applicant acknowledges that, any recipient of the CFDC's services shall assist in completing any evaluation of the outcomes and impacts (current or in the future) that result from obtaining services from the CFDC. A representative of the Federal Economic Development Agency for Southern Ontario, or a consultant obtained on their behalf, may contact you or your business to gather pertinent information to provide an evaluation of the impact of the CFDC's services and to request your cooperation to ensure a successful outcome. The Applicant is assured that all information will remain confidential.

3. The Applicant acknowledges that this application and other personal information may be retained by the CFDC whether or not any transaction is ultimately completed.

4. The Applicant acknowledges receipt of the CFDC’s Privacy Statement and hereby consents to his or her personal and business information being collected, used, retained and disclosed by the CFDC for the limited purposes as set out above. The Applicant further understands that under Federal privacy law, he or she has access to the information held by the CFDC and knows to refer to the CFDC's Privacy Policy or contact the Chief Privacy Officer if a question or concern arises about the handling of the Applicant's personal information.

5. The Applicant further understands and consents to the CFDC publicizing the Applicant's business venture if the Applicant is successful in obtaining financing from the CFDC, which may or may not include personal information such as the name of the Applicant and name of the business.

Community Futures Development Corporation (CFDC) is committed to protecting your privacy and the confidentiality of your personal information. Our privacy commitment is addressed in our privacy policies. The CFDC’s privacy policies and procedures have been developed to comply with Canada’s Personal Information Protection and Electronic Documents Act (“PIPEDA”).Adult Waiver / Media Consent

I hereby authorize any written material, images or video footage taken of myself, in whole or in part, individually or in conjunction with other written material, images and video footage, to be displayed on the South Lake Futures Website and other official channels, and to be used for media purposes including promotional presentations and marketing campaigns. I waive rights to privacy and compensation, which I may have in connection with such use of my name and likeness, including rights to be written copy that may be created in connection with video production, editing and promotion therewith.I/we have read and understand the Disclosure and Release Statement, Environmental Declaration, and the

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Collection, Use, and Disclosure of Personal and Business Information. Yes ____ No ____

Signed at ___________________ Date (DD/MM/YYYY) ______________

Signature of Applicant, Guarantor or Shareholder _____________________________

Signature of Witness ________________________

Signature of Applicant, Guarantor or Shareholder _____________________________

Signature of Witness ________________________

For Office Use: Date Received (DD/MM/YYYY) ______________________

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