CONTACT INFORMATION

ENTITY INFORMATION

Entity Status:

Existing Entity

New (proposed) Entity

Changing Legal Entity of Existing Business That You Currently Own/Operate

Other

Please Describe:

Current or Proposed Business Name:

Alternative Name:

(If first choice is not available)

Type of Business or Main Business Activity:

Type of Entity:

To Be Discussed

Limited Liability Company

C-Corporation

S-Corporation

General Partnership

Limited Partnership/LLP/LLLP

Non-Profit

Sole Proprietorship

Other

Explain:

Province of Business Formation:

Statutory Agent/Registered Agent:

(Who will initially sign the documents (e.g. filings) and open bank accounts on behalf of the business)

ENTITY ADDRESS

Street Address of Business:

City:

Province:

Postal Code:

ENTITY CONTACT INFORMATION

Telephone:

Email Address:

Is the business mailing address the same as above?

Yes

No

Address: City: Province: Postal Code:

Website for Business:

BUSINESS INFORMATION

Manager/Officer/Director Name #1:

Yes

Name: Title: Address: Date of Birth:

No

Manager/Officer/Director Name #2:

Yes

Name: Title: Address: Date of Birth:

No

Manager/Officer/Director Name #3:

Yes

Name: Title: Address: Date of Birth:

No

Manager/Officer/Director Name #4:

Yes

Name: Title: Address: Date of Birth:

No

INTENDED BANK AND EMPLOYEES

Name of Intended Bank:

Will you hire employees?

Yes

How many? When will you begin paying wages?

No

BUSINESS OWNER INFORMATION (Shareholders, etc.)

Business Owner #1:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #2:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #3:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #4:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #5:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #6:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #7:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #8:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #9:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Business Owner #10:

Yes

Full Legal Name: Address: Percentage of Ownership:

(or shares of stock)

SIN: Initial Contribution:

No

Important Information for Any Additional Business Owners.

PROFESSIONAL ADVISORS (Accountants, Lawyers, etc.)

Professional Advisor #1:

Yes

Name: Role: Phone: Address:

No

Professional Advisor #2:

Yes

Name: Role: Phone: Address:

No

Professional Advisor #3:

Yes

Name: Role: Phone: Address:

No

Professional Advisor #4:

Yes

Name: Role: Phone: Address:

No

CAPITAL/FUNDING

With what assets do you plan to fund the business with initially?

Have you taken out any loans to pay for startup costs of the business?

Yes

If yes, please describe the nature of the loan and identify the institution that holds the loan.

No

ADDITIONAL INFORMATION

Do you have a business plan?

Yes

Please attach, if available.

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No

Will the business use trademarks or logos?

Yes

If yes, please describe.

No

Do you own any real property related to the business?

Yes

If so, please provide the deed.

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No

Do you intend to offer employees/consultants equity-based compensation incentives?

(e.g. stock options, profits interests, etc.)

Yes

No

Will the business require any special licences?

(i.e. liquor, gambling, etc.)

Yes

If yes, please describe.

No

Does the company have a written or oral business succession plan?

Yes

No

Has the business ever been formally valued through a business evaluation?

Yes

Date of Valuation: Entity That Completed Valuation: Amount:

No

Amount the owners believe the company is currently valued at?

E-ACKNOWLEDGEMENT AND ACCEPTANCE:

I affirm and acknowledge that all of the above information is true and accurate to the best of my knowledge.

THANK YOU