INVESTOR
Name:
Adress:
City:		PC:
Phone (home):
Phone (off.):
Email:
Others Investor if relevant INVESTOR
Name:
Adress:
City:		PC:
Phone (home):
Phone (off.):
Email:
INVESTOR
Name:
Adress:
City:		PC:
Phone (home):
Phone (off.):
Email:
INVESTOR
Name:
Adress:
City:		PC:
Phone (home):
Phone (off.):
Email:

Corporate name:
Business Address:
Name of the person   to contact:
Phone:
Fax.
Email:

Please identifying the nature of your project :

Launch	Expansion	Acquisition	Consolidation
Year of establishment:		Period, end of year:

Jobs created :		Full time :		Part time :
Jobs maintained :		Full time :		Part time :

Auditor   (Accounting countable) :
Contact Person :
Phone :
Financial institution :
Contact Person :
Phone :

PROJECT NEEDS			FINANCING
Working Capital :			Capital outlay :
Equipment :			Loans :
Rolling Stock :
Others :
TOTAL :			TOTAL :

PLEASE, DESCRIBE YOUR PROJECT IN FEW WORDS

PLEASE, BE MORE SPECIFIC ON THE REQUIRED HUMAN RESOURCES

PLEASE, BE MORE SPECIFIC ABOUT YOUR PRODUCTS OR SERVICES

PLEASE, DESCRIBE YOUR MARKET
(Territory, clientele, competitors)

I here by give my consent to Centre d'Aide aux Entreprises Haute-Yamaska et région to make all necessary enquiries to obtain information concerning the present loan request send by email.

Your name :

Date (DD/MM/YY) :

Espace réservé au CAE 1er rencontre

Date d'ouverture : Responsable du dossier : Frais d'ouverture :