Loan Application | Community Futures Alberni Clayoquot

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Emergency Loan Funds Application

Personal Information

Email Address(*)

Please include a valid email address.

First Name(*)

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Middle Name(*)

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Last Name(*)

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Home Address(*)

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PO Box

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City Town(*)

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Postal Code(*)

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Do you rent or own your residence?(*)

OwnRent Invalid Input

Date of Birth(*)

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Phone Number(*)

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Business Information

Business Name(*)

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Business Phone Number(*)

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Business Address(*)

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Business Website

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Business PO Box

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Business City(*)

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Business Postal Code(*)

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General Information

Have you ever had an asset repossessed?(*)

YesNo Invalid Input

Are you involved in any claims or lawsuits?(*)

YesNo Invalid Input

Have you ever declared bankruptcy?(*)

Yes No Invalid Input

Do you owe any back taxes?(*)

YesNo Invalid Input

Please provide details if you answered yes to any of the questions above.

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Loan Details

Loan Amount Requested (<$20,000)(*)

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Describe what the money will be used for(*)

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I/We, the undersigned, declare that the statements made herein are for the purpose of obtaining financing and are to the best of my/our knowledge true and correct. I/We consent to Community Futures Development Corporation of Alberni-Clayoquot making any inquiries it deems necessary to reach a decision on this application, and consent to the disclosure at any time of any credit information about me/us to any credit reporting agency or to anyone with whom I/We have financial relations.

I agree to the reference and credit check statement above.(*)

Yes Invalid Input

Financials or Additional Files

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Emergency Loan Funds Application

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