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Apply Online For Financing

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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

_______________________________________

HEAD OFFICE

Suite #300, 1600 Bedford Highway

Bedford, NS Canada B4E1E8

Telephone: (902) 405-4003

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

 

 

 

 

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Last modified: 01/24/11