EmailMeForm
CHAPTER 11/7 OR CCAA BANKRUPTCY
Enter all amounts in $ USD.
This form is for any business entity who has filed for Bankruptcy Chapter 11, 7, or CCAA.
ALL QUESTIONS MUST BE ANSWERED
Submissions that state “See Attached” or have missing information will be considered incomplete and applicant will be required to re-submit the form.
Briefly describe what the borrowing company does:
How much capital is being requested?
*
Breakdown of the use of the loan proceeds:
Where is the borrowing company located?
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City/Town
State/Region
Country
Year company began:
*
All 3 Personal Credit Scores of the Principals (Equifax, Experian and TransUnion)
*
Equifax, Experian and TransUnion
Total Accounts Receivable now:
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Accounts Receivable over 90 days old:
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Total Accounts Payable over 90 days old:
*
Approximately how much are you billing per month?
*
Credit terms extended:
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30 days, etc.
Is the business seasonal?
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Yes
No
What % of sales are performed under contract with progress billing?
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Are there any tax deliquencies?
*
Yes
No
What % of customer base is outside U.S.A?
*
Does any customer account for more than 25% or A/R?
*
Yes
No
What is the current company net worth?
*
Estimate the liquidation value of Inventory (excluding work in progress):
*
Estimate the liquidation value of Equipment if it were liquidated:
*
furniture and telephone/computer equipment is not acceptable collateral
If the equipment has been appraised, for how much?
If no appraisal, leave blank
Date of Appraisal
If no appraisal, leave blank
Type of Appraisal:
Please select
FMV (Fair Market Value)
OLV (Orderly Liquidation Value)
FLV (Forced Liquidation Value)
No Appraisal
Estimated value of business owned Real Estate:
*
Estimated value of any other business assets:
*
Total secured debt (including mortgage) against company now:
*
Monthly payment now on secured debt:
*
Are the payments current?
*
Yes
No
2022 Revenue:
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2022 Net Income:
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2021 Revenue:
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2021 Net Income:
*
2020 Revenue:
*
2020 Net Income:
*
This year's projected Revenue:
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Amount of backlogged orders now:
*
Is the business currently making money?
*
Yes
No
If making money, for how many consecutive months?
if not making money, enter 0
Does the business have accountant prepared financial statements?
*
Yes
No
If so, when does the accounting year end?
What type of statement?
Select One
Audited
Reviewed
Compiled
No Statements Available
Who does the company typically sell products/services to?
*
What is the status of the plan of reorganization?
*
Briefly describe the circumstances that lead to the Chapter 11/7 filing:
*
Additional Comments that could be relevant for a lender's considration, if any:
Optional File Upload
ALL QUESTIONS MUST BE ANSWERED
Submissions that state “See Attached” or have missing information will be considered incomplete and applicant will be required to re-submit the form.
Resumes
3 Years Company Financial Statements
3 Years Company Tax Returns
Real Estate Owned Schedule (REO)
Personal Net Worth Statement (PNW)
Other
Signature
Name of person completing form:
*
Phone:
*
Email:
*
Confirm
Person completing the form is:
*
Broker
Principal Borrower(s)
Other
Referral Information (if applicable)
Name of person who referred you:
Email of person who referred you:
Account Executive (if applicable)
If you have been assigned an Account Executive (other than the person who referred you), please enter their email here.
