ACCESS Business Loan Application Form

Business Loan Application
ACCESS Community Capital Fund’s Small Business Loans Program offers eligible first-time applicants loans up to $5,000
and second loans to returning clients of up to $10,000 to launch or grow a small business.
Please submit the completed form with supporting documents by email to: biz@accessccf.com.
PART ONE: PERSONAL CONTACT INFORMATION
First and Last Name: Click here to enter text.

Home Address: Click here to enter text.
City: Click here to enter text.
Province: Click here to enter text.
Postal Code: Click here to enter text.
Cell Phone: Click here to enter text. Home Phone: Click here to enter text.
Personal Email: Click here to enter text.
Business Email: Click here to enter text.
Business website/social media profile, if applicable: Click here to enter text.
What is your status in Canada? Citizen ☐ Permanent Resident ☐ Convention Refugee/Protected Person ☐
Gender: Male ☐ Female ☐ Non-binary ☐
How did you hear about ACCESS? Click here to enter text.
PART TWO: FINANCIAL INFORMATION

Our mission is to help people who are unable to receive funding from traditional lending institutions.
Have you been declined for a loan by a bank or other lending institution? If yes, please explain why: Click here to enter
text.
If you have not applied elsewhere for a loan, is there a reason you believe you’d not be successful? Click here to enter
text.
What is your main source of income? (E.g. employment, government benefits, etc.): Click here to enter text.
What is your total monthly household income? Click here to enter text.
What are your total monthly household expenses? Click here to enter text.
If there are any other details to help us understand your financial situation, please describe: Click here to enter
text.
1
Business Loan Application
PART THREE: APPLICANT CONSENT & DECLARATION
I, Click here to enter text. (applicant’s name) declare that I am applying for the ACCESS loan in good faith and have
provided the required information truthfully to the best of my ability.
I agree to provide ACCESS, as part of their eligibility assessment, with my personal information and relevant documents
that may be required.
I recognize that, as part of their due diligence, and in order to render a good decision, the ACCESS team will undertake to
verify the information provided by me in this application.
I confirm that, in providing personal information of an individual, such as a family member or reference, I’ve obtained
their authorization and consent.
I authorize ACCESS to share my personal information with relevant and approved persons (e.g. ACCESS Loan Review
Committee Members, ACCESS staff, and Alterna Savings) for the loan assessment and disbursal purposes.
I understand that ACCESS and members of the Loan Review Committee (LRC) have pledged to treat this information with
the strictest confidence and will ensure that no person outside the ACCESS staff and volunteers has access to it.
I understand that ACCESS collects, uses and discloses my personal information for: detecting and preventing fraud;
compiling statistics, conducting market research and report to regulatory and funding agencies; investigating and settling
claims; referring me to financial planning services and other purposes as permitted or required by law, e.g. the checking
of a credit report by Alterna Savings.
I understand that the ACCESS privacy policy governs the collection, use and disclosure of my personal information.
I consent to being contacted for the purposes of market research related to the ACCESS loan program.
I acknowledge that ACCESS, its staff and volunteers will bear no liability, contract or otherwise for any loss, damage or
claim, judgement, cost or expense of any kind that I assert or sustain as a result of any advice or services received in
connection with this loan application or granting of a loan under the ACCESS Small Business Loans Program.
I agree to indemnify ACCESS, its staff, volunteers and partners, and to hold each harmless from any and all proceedings,
damages, and liabilities, directly or indirectly, incurred by or taken, against any of them in connection with this loan
application or the granting of such a loan under ACCESS’ Small Business Loans program.
First and Last Name: Click here to enter text. Date: Click here to enter text.

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ACCESS Business Loan Application Form

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Business Loan Application

PART ONE: PERSONAL CONTACT INFORMATION

First and Last Name: Click here to enter text.

PART TWO: FINANCIAL INFORMATION

PART THREE: APPLICANT CONSENT & DECLARATION

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