Funding Application | Emerald Express Financial

Step 1 of 3

Business information

Tell us about the business requesting funding.

Legal Business Name* Enter the registered legal name of the business.

Operating Business Name* Enter the name the business operates under.

Head office address*

Street address is required.

Required.

Date of Incorporation*

- -

Please provide the date of incorporation.

Industry* Please enter the industry.

Business Number (GST/HST #)* Required.

Number of Employees* Required.

Ownership & structure

How many shareholders are there?* Required.

Number of business bank accounts (optional)

Entity Type*

Please select an entity type.

Monthly Business Revenue*

$

Required.

Step 2 of 3

Owner(s)

The owner(s) completing this application.

Owner 1

Full Legal Name* Required.

Owner Percentage (%)* Required.

Home address*

Street address is required.

Required.

Date of Birth*

- -

Required.

Credit Score* Rough range is fine. Required.

Have you been bankrupt before?*

Please select an answer.

Social Insurance Number (SIN) (optional)

Signature*

Signatures – all owners must sign –

By signing below, the Client and its owner(s) certify that all information and documents submitted in connection with this Application are true, correct and complete. Additionally, the owner(s) authorize Emerald Express Financial Ltd. or any of its agents, partners, and affiliates to contact the above landlord, supplier, and emergency contacts, as well as obtain and use business and non-business consumer credit reports from credit reporting agencies and any other information regarding the Client and its owner(s) from third parties, both at the time of the initial funding application and at any time after the Client has received funding as long as the Merchant remains a client of Emerald Express Financial Ltd. At all times, Emerald Express Financial Ltd. will comply with the personal information collection, protection, use, sharing, and retention practices set out in the Privacy Policy

Sign here with your mouse or finger

Draw your signature above.

Please draw your signature above.

Date signed

- -

First Name

Last Name

Owner Percentage (%)

Home address

Date of Birth

- -

Credit Score Rough range is fine.

Social Insurance Number (SIN) (optional)

Have you been bankrupt before?

Signature

Signatures – all owners must sign –

By signing below, the Client and its owner(s) certify that all information and documents submitted in connection with this Application are true, correct and complete. Additionally, the owner(s) authorize Emerald Express Financial Ltd. or any of its agents, partners, and affiliates to contact the above landlord, supplier, and emergency contacts, as well as obtain and use business and non-business consumer credit reports from credit reporting agencies and any other information regarding the Client and its owner(s) from third parties, both at the time of the initial funding application and at any time after the Client has received funding as long as the Merchant remains a client of Emerald Express Financial Ltd. At all times, Emerald Express Financial Ltd. will comply with the personal information collection, protection, use, sharing, and retention practices set out in the Privacy Policy

Sign here with your mouse or finger

Draw the second owner's signature above.

Date signed

- -

Step 3 of 3

Funding request

What you're looking for, a couple of quick questions about your finances, and your final confirmation.

Requested Funding Amount*

$

Required.

Describe your business funding needs (optional)

Do you have any unsecured debt?

Do you have overdraft protection?

Bank statements

Attach your last 3–6 months of business bank statements below. Sole proprietors can upload personal bank statements.

Drop files here or click to browse

Any file type, any number of files

0 MB attached

I confirm the information provided in this application is accurate to the best of my knowledge, and that my typed or drawn signature above is intended as my legal signature. Please confirm before submitting.