Kingsmen Capital Alberta

Business Funding: Client Intake Form

Please answer the following questions to better understand your goals. Your responses will provide valuable insight.
Submit the Kingsmen Business Funding: Client Intake form.
Book an appointment on a day and time that suits you best. (Otherwise, we will contact you in 1-2 business days.)

BUSINESS DETAILS

1. What is the legal name of your business? *

3. How long has your business been operating? *

Under 6 months

6–12 months

1–2 years

2+ years

4. What is your business’s average monthly gross revenue (within the last 6 months)? *

$

6. What is your target funding range? *

7A. Other - (please specify) . Primary use of funds

FINANCIAL SNAPSHOT

8. Do you currently owe any balances to CRA (business taxes)? *

Yes

No

8A. If Yes: Are you current or in arrears?

8B. If Yes: Approximately how much is owed?

$

9. Do you own 100% of the business? *

Yes

No

9A. If No: What percentage do you own?

9B. If No: How many partners do you have?

CONTACT INFORMATION

10. Full Name of Primary Contact / Business Owner *

11. Primary Contact Number *

12. Email *

MARKETING & ATTRIBUTION

13A. Other - (please specify)

14. Is there anything else we should know about your business or current situation?

*

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