PME Fund Application

Company

* Full legal name

* Trade name

* Address

Suite

* City

* Province

* Postal Code

* Phone (Bus.)

* E-mail

* Amount requested

* Purpose

* Operating

* Leaseholds

* Equipment

* Other

* Details regarding purpose of the investment

Company URL, if any

If you have a demo, what's the URL? Demo can be anything that shows us how the product works.

Please provide a link to the product, if relevant. Followed by the login credentials, if required.

Product URL

Username

Password

LinkedIn account if any

Twitter account, if any

Facebook page, if any

* Business start-up date

* Describe what your company does in 50 characters or less.

* What is your company going to make or what service will it provide? Please describe your product or service and what it does or will do.

Founders

(Founders must have at least 10% equity in the company and must each apply separately)

* Principal owner

* Role/function

* Full time

* Equity

* Have you taken any investment yet?

* Are you currently fundraising?

* Is there another co-founder?

Do you have a shareholder’s agreement?

If you have not formed the company yet, describe the planned equity ownership breakdown among the founders, employees and any other proposed stockholders.

If there are multiple founders, be sure to give the proposed equity ownership of each founder and founder title (e.g. CEO).

* Have you ever submitted an application with ProMontreal Entrepreneurs?

* Has your business ever filed for bankruptcy or defaulted on any debts?

* Is your business a party to any claim or lawsuit?

* Has this business guaranteed the financial commitments of others?

Progress

* How far along are you?

* How long have each of you been working on this? How much of that has been full-time? Please explain.

* Are people using your product?

* Do you have revenue?

Idea

* Why did you pick this idea to work on? Do you have domain expertise in this area? How do you know people need what you're making?

* Who are your competitors? What do you understand about your business that they don't?

* Are any taxes (GST, QST, business, real property) in arrears?

* How do or will you make money?

Curious

* How did you hear about ProMontreal Entrepreneurs?

Personal Information

* First Name

* Last Name

Maiden Name

* Date of birth

* Home Address

Apt.

* City

* Province

* Postal Code

* Phone (Home)

* Phone (Cell)

* Marital status

No. of dependent children

Work Information

Company

Position

Salary per annum

Start date

Address

Suite

City

Province

Postal Code

E-mail

Personal Balance Sheet

* Personal Balance Sheet as of

Assets

* Deposits

* Cash

* Term deposit

* Mutual funds

* Stocks

* RRSPs

* Residence

* Real estate

* Vehicle

Other (please specify)

* Total Assets

Liabilities

* Mortgage(s)

* Loans

* Credit cards

* Personal line of credit

Other (please specify)

* Total Liabilities

Net Worth

* Total Assets minus Total Liabilities

Personal Income Statement

* Gross monthly income

Other $ (please specify)

* Total Income

Monthly Payments

* Mortgage

* Property taxes

* Loan payments

* Credit card payments

* Support payments

* Rent

Other $ (please specify)

* Total Expenses

* Have you ever filed for bankruptcy or defaulted on any debts?

* Are you a party to any claim or lawsuit?

* Have you personally guaranteed the loans or financial commitments of others?

* Are any taxes (GST, QST, business, real property) in arrears?

If “yes” to any of above, please provide details.

Acceptance

Name of Applicant

* Acceptance

I accept the Terms and Conditions (read)
I accept Federation CJA's Privacy Policy (read)

* Date

Business Plan