Employer Name & Address: Phone: Occupation: How Long: Gross Annual Income: Previous Employer (if less than 3 years): How Long: Individual Applicant’s Education and/or Training: Please describe secondary and post-secondary courses and training you have received; start with the most recent. Include any degrees, certificates and designations. Grade / Diploma / Completed Name of Institute Year Attended Location Area of Study / Course Certification / Yes No Degree Individual Applicant’s Summary of Net Worth: Cash and/or Bank Balance $ Charge Accounts (Credit Cards) $ Real Estate $ Mortgages $ Vehicles $ Loans Vehicle $ – Equipment $ Loans Equipment $ – Inventory $ Loans Personal $ – Other $ Accounts Payable $ (specify) Other $ Other $ (specify) (specify) Total Assets (A) $ Total Liabilities (B) $ Net Worth: A B = $ – Section B: BUSINESS INFORMATION All Applicants must complete this section – Business Structure: Partnership (Each partner must complete a separate application in full) Corporation (Each shareholder must complete a separate application in full) Co-op Sole Proprietorship Other: New Proposed Business Date: Business Status: – Month Day Year Existing Are previous financial statements available and attached? – Acquisition Business Name: Business Mailing Address:
Employer Name & Address: Phone: Occupation: How Long: Gross Annual Income: Previous Employer (if less than 3 years): How Long: Individual Applicant’s Education and/or Training: Please describe secondary and post-secondary courses and training you have received; start with the most recent. Include any degrees, certificates and designations. Name of Institute Year Attended Location Area of Study / Course Grade / Diploma / Certification / Degree Completed Yes No Individual Applicant’s Summary of Net Worth: Cash and/or Bank Balance $ Charge Accounts (Credit Cards) $ Real Estate $ Mortgages $ Vehicles $ Loans – Vehicle $ Equipment $ Loans – Equipment $ Inventory $ Loans – Personal $ Other (specify) $ Accounts Payable $ Other (specify) $ Other (specify) $ Total Assets (A) $ Total Liabilities (B) $ Net Worth: A – B = $ Section B: BUSINESS INFORMATION – All Applicants must complete this section Business Structure: Partnership (Each partner must complete a separate application in full) Corporation (Each shareholder must complete a separate application in full) Co-op Sole Proprietorship Other: Business Status: New – Proposed Business Date: Month Day Year Existing – Are previous financial statements available and attached? Acquisition Business Name: Business Mailing Address:
Business%20Support%20Programs%20application.e-form.2016.01.29.docx