~ TWO RIVERS COMMUNITY DEVELOPMENT CENTRE ~

PART 1 - PROJECT DATA

1. Name of Applicant:

E-mail:

Business Address:

2 Band Name:

Band Number:

3. Describe your business and what you are proposing for a loan:

4. Business Structure:
Proprietorship: Partnership: Corporation: Other:

5. New Business: Existing Business: Since:

6. Financing: (What are you going to USE the money for and what SOURCES
are you going to get it from?)

Use of Funds	$	Source of Funds	$
		TRCDC Loan
		Other Financing
		Applicant Equity
		Other
Total Use of Funds		Total Source of Funds
* Total use of funds must always equal the total source of funds. *

7. Describe applicant equity: (i.e. What do you have to put into the project or
what have you already invested into the project?)

8. Describe other sources of financing: (i.e. ABPD, Bank, etc.)

9. List previous bank loans you have had for this business:

10. Other items important to this project:

PART II - PERSONAL DATA

1. Name:

Position:

Address:

Postal Code:

Phone Number:

( ) -

Date of Birth: MM/DD/YYYY

S.I.N:

Single: Married: Number of Dependants:

Name of Spouse:

2. Education:

Last Grade Completed:

School:

Province:

Other Training/Courses:

Length of Training:

School Location:

Year Completed:

3. Employment History: (From most recent position)

	From - To	Employer	Nature of Work	Wage
I
II
III

4. Personal Net Worth As Of: (MM/DD/YYYY)

Assets:	$






Total Assets - (A):

Liabilities: (Include debts guaranteed or consigned)

Lender	Purpose	Terms	Outstanding	Arrears




Total Liabilities - (B):		$
Personal Net Worth: (A) - (B)		$

5. Banking References:

Bank	Town	Address

6. Other Important Information:

Statement of Client: I certify, that to the best of my knowledge, the information given on
this application is true and correct. Two Rivers Community Development Centre is hereby authorized to check the accuracy of the information and obtain credit reports on me and exchange information with other creditors.

Signature of Applicant: (Please type in your name)