COMMERCIAL MORTGAGE APPLICATION				Asset Capital Mortgage North America Finance Group 3352-11215 Jasper Ave. Edmonton AB Canada T6K 2H5 Phone 780-906-4775 Fax 780-669-7087
Customer Information
Business Name (Lessee)								Phone
Address								Fax
City				STATE / PROV		ZIP / POSTAL CODE		E-MAIL
YEARS IN BUSINESS	TYPE OF BUSINESS ^___ CORPORATION ___ PROPRIETORSHIP ___ PARTNERSHIP
CORPORATE SECRETARY				DATE OF INC.		STATE / PROV OF INC.		FED TAX ID NO. / CORP ACCESS NO.
INFORMATION ON PRINCIPALS
NAME				SOCIAL SECURITY NO. / SIN				TITLE
HOME ADDRESS	CITY			STATE / PROV		ZIP / POSTAL CODE		HOME PHONE
NAME								TITLE
HOME ADDRESS	CITY			STATE / PROV		ZIP / POSTAL CODE		HOME PHONE
PERSONAL GUARANTEE OF OWNERS OFFERRED ___ YES ___ NO
BANK REFERENCES PLEASE (please supply two)
1^ST BANK NAME				BRANCH				PHONE
BANK CONTACT						ACCOUNT NUMBER
2^ND BANK NAME				BRANCH				PHONE
BANK CONTACT						ACCOUNT NUMBER
TRADE REFERENCES (please provide two)
1^ST TRADE NAME		CONTACT				ACCOUNT NO.		PHONE
2^ND TRADE NAME		CONTACT				ACCOUNT NO.		PHONE
LOAN DETAILS
AMOUNT REQUIRED $					REPAYMENT TERM REQUESTED
PUPOSE OF LOAN
FINANCIAL DETAILS TO BE INCLUDED
1 – 3 YRS AUDITED ACCOUNTING RECORDS			CASH FLOW FORCAST 3 YEARS				BUSINESS PLAN
DETAILED USE OF FUNDS LETTER			ARE ANY OTHER GUARANTEES AVAILABLE ___ YES ___ NO				LIST ALL AVAILABLE SECURITY /APPRAISALS ETC.
NOTES:
AUTHORIZATION ASSET CAPITAL MORTGAGE CORP OR ITS ASSIGNS ARE AUTHORIZED T0 CHECK WITH ALL REFERENCES LISTED ABOVE AND TO MAKE ANY OTHER INQUIRIES TO FACILITATE A CREDIT DECISION AND YOU HAVE PERMISSION TO USE THIS INFORMATION FOR UNDERWRITING OUR REQUEST. ALL INFORMATION PROVIDED HERE IS TRUE AND ACCURATE.
X____________________________________________________________ ___________________________________________________________ ____________________________________ AUTHORIZED SIGNATURE PRINT NAME AND TITLE DATE
Fax This Application to 780-669-7087 Thank You For Your Business www.assetcapitalmortgage.com sales *at* assetcapitalmortgage.com