Equity Contribution

							                            Clarence Campeau Development Fund
                        APPLICATION FOR EQUITY CONTRIBUTION
 Name of Applicant:

 Trade Name of Business:

 Your Business is:      ¨ A Proprietorship          ¨ A Partnership     ¨ An Incorporated Company               Business Phone No.:

 What Type of Business Is This:

 Mailing Address:                                           City/Town                      Postal Code


 Amount Being Applied        Reason You Are Applying For This Contribution:
 For:

 $



 BELOW PLEASE INDICATE WHAT YOUR PROJECT COSTS WILL BE AND THE AMOUNT OF
 FINANCING REQUIRED
PROJECT COSTS:                                                                  FINANCING:
Land and Buildings                              $                               CCDF                                     $

Machinery & Equipment                                                           Bank/Credit Union

Vehicles                                                                        Cash Equity

Leasehold Improvements                                                          Other (specify)

Working Capital

Administration Fee
(1% of Contribution Request)

Other (specify)

TOTAL                                           $                          =    TOTAL                                    $
Names of Owners of the Business:                      Position Held:           % Owned              MNS Membership No.
                                                                                           (Attach copy of Membership
                                                                                            Card to Application Form)



Name of Your Business's Bank:

Branch Address:

Phone Number:

Existing Limit on Operating Line of Credit: $


OUTLINE EXISTING BUSINESS LOANS:
Name of Lender        Original Amount    Due Date               Present Amount Due     Interest Rate   Repayment Terms    Security Given
                      $                                         $                               %


Name of Lender        Original Amount    Due Date               Present Amount Due     Interest Rate   Repayment Terms    Security Given
                      $                                         $                               %



ADMINISTRATION FEE:
The Fund will be charging an administration fee 1% of the approved contribution to cover the initial expense
for preparation and security documentation.
CREDIT INFORMATION:
The Applicant hereby grants the Clarence Campeau Development Fund the authority to conduct any credit
checks, inquiries and property searches from other agencies and sources it deems necessary to reach a
decision on this application or necessary to administer the loan and consents to the disclosure at any time
of any credit information about the applicant to any credit reporting agency or to anyone whom I/we have
financial relations.

RIGHT TO PUBLICIZE:
The applicant hereby grants the Clarence Campeau Development Fund the right to make public
announcements related to the funding granted, to erect signs or other notices on the site of projects
involving construction or expansion of an existing enterprise, and in general may publicize or advertise any
details related to the funding granted.

DECLARATION:
The statements and information herein and those attached which form part of this application are for the
express purpose of obtaining financial assistance from the Clarence Campeau Development Fund and are
to the best of my/our knowledge and belief, true and correct.

The Applicant hereby declares that none of the principals or guarantors are undischarged bankrupts or have
any bankruptcy proceedings in existence with respect to themselves or companies which they operate.

The Applicant hereby further declares that he/she is not associated (that is an officer or director, or spouse
or child of an officer or director) with the CCDF or the Metis Society of Saskatchewan.

The Applicant hereby declares that he/she is of Métis ancestry.


DATE
                                                            Applicant/Company




                                                            ___________________________
                                                            Authorized Signature


Seal (if applicable)
                                                                     *Please Note:
A Personal Statement must be provided with this application for each owner of the Business and
                                      any Guarantors


Please attach a copy of your Metis Nation of Saskatchewan membership card or other proof of Metis
ancestry to your application form.