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Business Location

What type of financing are you interested in?

Business Information

Business Legal Name

DBA / Operating Name

In Business Since

(MM/YYY)

Corp Structure

Business Phone Number

CRA Business Number

Website

Street

City

Country

Postal Code

State/Province

Nature of Business

Requested Loan Amount

Enter numbers only. Loans over $250k require collateral information.

Annual Revenue

Services Provided

How will the funds be used?

Contact Information

Legal First Name

Preferred Name (Optional)

Last Name

Phone Number - Personal

Title/Position

Percentage of Ownership

Social Insurance Number

e.g (123-456-789)

Birth Date

e.g (2000-12-13)

Street

City

Country

State/Province

Postal Code

Additional Shareholders Please disclose all shareholders to ensure total ownership equals 100%.

Full Name

Shareholder 2 Email

Percentage of Ownership

Additional Information

	Yes	No
1. Does this Business have more than 1 location?
2. Has the Business ever filed for bankruptcy, CCAA, proposal to creditors, or similar?
3. Have any of the Business owner(s), director(s) or officer(s) ever filed for bankruptcy, proposal to creditors, or similar?
4. Have any of the Business owner(s), director(s)'z or officer(s) ever filed bankruptcy, CCAA, proposal to creditors, or similar for ANY business they have been an owner, director or officer?
5. Does the business have any past-due amounts, including payment plans, with government agencies (e.g., Source Deductions, GST/HST, PST, Income Tax, EHT, etc.)?
7. Are there any legal actions, including pending or looming actions or judgments, against the Business?
8. Does the Business have any current active loans/liens? If so, what is the status?
9. Have you ever been convicted of a criminal offense that has not been pardoned?
10. Are your personal income taxes for the previous year(s) fully satisfied?
11. Are there any legal actions, including pending or looming actions or judgments, against you personally?
12. Are you a co-signer, guarantor, or obligor to any other party’s debts?
13. Have you (or has the Business) had any previous dealings with Accord Financial (any division or subsidiary)?
14. Do you (or does the Business), to your knowledge, have any outstanding issues (including CRA)? If so, please provide details.

Additional Comments

Please use either the Equipment Breakdown or Document upload.

Equipment Breakdown

Condition

Equipment Description (Year/Make/Model)

Purchasing From

Quantity

Requested Term (Months)

Equipment Cost

Equipment Document

Please either manually enter asset values or use the document upload.

	Included in Facility	Estimated Value	Requested Limit	Currently Enbumbered	Balance Outstanding
Account Receivable
Inventory - Finished Goods
Inventory - Raw Materials
Machinery/ Equipment
Real Estate

Does this business currently have an operating line of credit or other financing facilities?

Select

Financial Institution

Balance

Credit Limit

Asset Breakdown Document

Submitting financial statements at this stage is optional. However, providing all required documentation now allows our credit team to process your application without delay.

Flinks- By using Flinks, we can confidently tailor financing options, ensuring that we can offer you the most appropriate and highest credit limit possible.

Please follow the prompts below to provide temporary secured view-only banking access.

Disclosure and Consent Statement for Electronic Communication Authorization for Communication with Parties Listed in the Credit Application The undersigned certifies the above information to be true and correct.
By signing below, I consent and authorize Accord Financial Canada Corp. (“Accord”) and its assigns, affiliates and representatives, at any time to obtain on an on-going basis, verify, use, communicate with and disclose to third parties (including credit reporting agencies, credit exchanges, leasing brokers, and credit grantors, on an on-going basis) any of my credit, financial, and personal information that Accord deems necessary to complete, service or enforce any lease, ancillary deed or transaction, including but not limited to assignments and securitizations. You authorize us to collect, hold, exchange and disclose your personal information as requested in order to administer your contract and determine your insurance eligibility as required or permitted by law. You also authorize us to use your personal information for internal statistical analysis purposes. If you would like to review your own personal information, correct or revise existing information, have any questions, concerns or comments regarding it’s application please fax 1-888-835-9757 (Attn: Privacy Office) or mail #300-889 Harbourside Drive, North Vancouver, BC V7P 3S1 Attn: Privacy Office.

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