* mandatory information        
  Privacy Policy 
 
  Financing Inquiry Form
for Purchases of Goods and/or Services from Canada 		   
 
  Equivalente em português.
  Oprima aquí para la versión en español.
 
  CANADIAN SUPPLIER INFORMATION__________________________________________________________________
 
  * Have you identified a Canadian supplier?   Yes No    
 
  List of purchases for which financing is required:    
 
 
* Canadian Company * Contact Name * Phone Number
Product being purchased
Value of Purchase in US$
( ) - ext.
( ) - ext.
( ) - ext.
   
 
  YOUR COMPANY _________________________________________________________________________________
 
  * Legal Name of Your Company:      
  Trade Name (if applicable):    
  * Address:      
  * City:      
  Province/State/Other:      
  * Country:      
  Postal Code/Zip:      
  Website:      
 
  CONTACT INFORMATION___________________________________________________________________________
 
  * Salutation:      
  * First Name:      
  * Last Name:      
  * Title:      
  * Telephone (numbers only):      
  Fax (numbers only):      
  * E-mail:      
 
  YOUR BUSINESS_________________________________________________________________________________
 
  Date Established:      
  * Description of Business:      
  Total Assets (in USD):      
  Volume of Sales (in USD):      
  Do you have a bank engaged?   Yes No    
  Bank Name:      
 
 

YOUR REQUEST__________________________________________________________________________________ 		   
 
  Type of financing requested:   One time purchase
Multiple purchases (within 6-18 months) 		   
 
  Amount Requested:      
 
  Currency:   CAD   USD    
 
  Comments: