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Request for Funding Form


All funding requests must be registered with us. Please attempt to answer all Questions below the 1st time
to save a delay in processing the request.   Should you have questions regarding this form, please feel free to call or
 e-mail your questions ASAP.  When possible please type this form .  (Please use Microsoft Word to complete/edit  this

This FORM is not intended for use as a credit or bank application. The information from this FORM is to provide Global
 the ability to focus on the direction taken to utilize  the best opportunity with Global’s  various sources for funding.

  Equipment Purchase, Loan, Venture Capital, Joint Venture, Debt refinance, and/or
 combination Application.

 Start Date:                                                                                                            Date Completed:_________

 Amount of  Funds Requested:  USD $                                                

1). Exact Location of Project:  

Company  Name:                                                                    Legal Signatory:

Physical Address:

         City:                                                State:                    Country:            Zip Code:

Company Phone:                                                           Fax:                              

After Hours #:

Fed – Country  ID #:                                                     SIC:

Company Email Address:                                           Web Site:

      Name(s) of  principal  Share Holders & percentage (%) of Ownership for control:                       


2.)  Exact Location of  Applicant:  

        Principal(s) Full Legal Name:

        Date of Birth:                                                                 Place of Birth:

        Percentage (%) of Ownership:                   U.S. Citizen:  Yes ___ No ___

        Percentage (%) –other Companies:               

        Residence Address:

        City:                                                State:                      Country:                     Zip Code:         

        Telephone #:                                                                Fax #:

          Mobile #.                                                                     After hours #.      

        Social Security#:                                                         Email Address:    

          International  Tax #

3). Project Description; (Brief), Full executive summaries will NOT be accepted on this form:

4). Humanitarian/Environmental Impact (if any):

5).           A. Description of request outline   for   ‘Use of Funds‘:

B. How much of your own money do you currently have at risk in association with this   project?   Please explain.

                C. Can you provide proof of personal investment?  Yes ___ No ___


6). Funding Structure Desired (Debt, Equity, Combination. Other.):

7). Funding Type Requested (Bridge loan /Interest only, (1st year - 5 yr fixed rate,  etc...) :

8). Financing or Investment Terms Requested:

9). If Construction or Renovation loan, time frame projected in months:

9a). If Construction or Project what is the value with loan in place:

10). Business Type:

11).        Stage of Request.  Select #  from below. (required) _________________

                                 Definition             ( Delete / Erase / Cross Out -categories that do not apply )

1.      Pre-Start-Up                  Venture in need of seed capital for R&D.

2.      Start-Up                         Venture ready to begin commercial operations.

3.      Other Early Stage         Organized Company operating less than 2 years.

4.      Expansion                      Capital for growth of an established firm.

5.      Mature Firm                    A Company over five years old.

6.      Business Acquisition   Investment. Define.

12). Use of Funds Summary:  

13). What Current Assets, Collateral, and/or Investment do you have in this project? 

(Note: This is for assets currently owned. If you do not own it now, do not enter it here):

14). Value of Current Collateral - Investment offered in US $

(Note: If you do not own it now, do not enter it here):

15). Value of Other and/or Future Collateral as part of new funding Offered: US$

16). Annualized Income from Project for year 1-3 :  1. US$ ____ 2. US$ ____ 3. US$ ____

17.) Collateral. __________________________________

17). Guarantees (other than personal) Available:  Yes ___      No ___


18). Documents Available for Review if Requested;  detailed list :

19). Corporation Status: (Select One)  Good Standing?      Yes ___ No ___                                                                                                                                 Active?   Yes ___ No ___   Inactive?     Yes ___ No ___

20). Corporation Registration:  (Select One)  Send copy.


Type of Corporation:  C – Corp. ___  S – Corp. ___ LLC  - Corp. ___

            (Select One)   Public?___  Private Corporation? ___


·Company Name:                                        State of Incorporation:


·Resident Agent Name:                             Address:

·Telephone:                                                 Fax:

·E-mail:                                                         Mailing Address:

·Express Delivery Address (if different):


21). Strategic Alliances list?

22). Copy of trade mark registrations available?     Yes ___ No ___


23). Copy of Patent available?       Yes ___ No ___
24). Copy of all licenses available?
Yes ___ No ___
25). Copy of any Franchise agreement available, if applicable? 
 Yes ___No ___

26). Management Résumes available?    Yes ___ No ___
27). Market Analysis available ? 
 Yes ___ No ___
28). Pricing documentation available?  
 Yes ___ No ___
29). Financial Data available?  2-3 years 
 Yes ___ No ___
30). Personal Balance Sheet available?   2-3 years.
 Yes ___ No ___

31). Current Assets vs. Liabilities: (Detail:) 

32). Are you aware of any unfavorable Credit records that may exist at any credit agency? 

Yes ___ No___     If Yes, Please detail here:

33). Credit Rating?             (Select One)

A Credit - 700 & above (Strong Cash Flow & Balance Sheet)

B Credit - 670 (Good Cash Flow & Balance Sheet)

C Credit - 630 (Okay Cash Flow, Weak Balance Sheet)

D Credit - below 630 (Story Credit, Needs Additional Support)


34). Any Outstanding Litigation Against Firm or Officer(s)?   Yes ___No ___

35). Why are you using outside investment services instead of your corporate and/or personal banking contacts?

36). If, a loan facilitator requires a retainer or final due diligence requires an on-site inspection of properties
and/or original documents are you prepared to pay for this?

                Yes ___No ___   Comment:

37). Upon receipt of acceptable loan terms and/or if necessary, are you prepared to furnish a performance bond
or similar document independent of loan proceeds? If so, what will be provided?   Yes ___No ___   Comment:

38). Do you have collateral and or cash flow which could be used that  is not  project related? 

Yes ___No ___   Description:



39).           Drivers License or Passport Identification:  / SKIP   - Foreign only.

1. Drivers License or Passport Number:

2. Drivers License or Passport Country/State of Origin:

3. Drivers Licence or Passport Expiration Date:

4. Drivers License or Passport Name: 


40).         A). How long has client  been searching  for funds?  ______________months

      B). If others have reviewed your project, what are the reasons that it has not received

 funding?  SKIP



Are you currently  in the process of  financing  with other lenders?    Yes ___No ___

               If Yes, List all lenders you have contacted within the last 60  days:


     D). Is there  brokers  involved?                                   Yes ___No ___    #._____

     E). Name of Originating Brokers.                             1.   ____________________________


                    Other.                                                              ______________________________ 


     F). Have you signed any contracts with broker ?   Yes ___No ___

                                      If Yes, with whom?


·  A Non-Circumvention, Non-Disclosure Working / Fee Agreement must be signed and submitted as part of this
information. Attached.

                                                                                                Yes ___No ___

·  A Full Business Plan has been prepared and is available as required.

                                                                                                Yes ___No ___

·  An Executive Summary has been prepared and is submitted as part of this information.

                                                                                                        Yes ___No ___                                                                                  

· A Business plan  has been prepared and is submitted as part of this information.

                                                                                                Yes ___No ___

·  A Pro Forma for the referenced project has been completed and is submitted as part of this information.

                                                                                                Yes ___No ___

·  Resumes for the Management/Executive Officers have been completed and is submitted as part of this

                                                                                                Yes ___No ___

·   A  Draw Down Schedule for the referenced project has been completed and is submitted as part of this
Yes ___No ___



 Your Questions  / Comments:










This agreement is made in connection with current business transactions/discussions as
of Date: ______ in regard to Business, Real Estate and/or Project transactions that are in need of  1. financing  2. Funding Sources,  3.financial consulting or 4. other services  listed, etc.

Project  Description / Requirement________________________________________________________


Groups involved with the parties listed or registered should be responsible to this NCND
Agreement. All other individuals shown material that is involved with the Client and/or the
 Project will also be registered by the key Parties herein.


This agreement is reciprocal between the signatories concerning the privileged information and
 contacts of each. The undersigned parties, with the intention to be legally bound, hereby irrevocably
 agree not to circumvent, avoid, bypass, or obviate each other, directly or indirectly, to avoid payment
 of fees, or commissions, or any transaction with any company partnership, or individual whatsoever,
  revealed  by either party to the other; in connection with any project or currency exchange, or any
loans, be it collateral, or funding, or any other transaction involving any products or services or
addition. Also the re-negotiation, renewal, extension, rollover, amendment, new contracts/
agreements, parallel contracts/agreements, or introduction and transactions to third parties thereof.
This agreement is valid for a three  (3) year period from the date of the last transaction and/or
signature with date. 


Nor shall either party disclose or otherwise reveal to any third party, any confidential information
 provided by the other, particularly such concerning sellers or lenders, or buyers or borrowers names
 addresses, telephone, telex, fax or e-mail, or any other means of access thereto, as well as
bank/financial information given to the other as being confidential or privileged without specific written
and formal consent of the other. This agreement shall not  apply to any banks, lending institutions,
corporations, or other entities with whom the non-introducing signatory has previously been a
 correspondent or broker, unless by mutual consent. (Upon registration-introduction of Party’s
Client it is clearly determined that a prior relationship existed and that the mutual parties will benefit
from progressing with the acknowledged party in question.) In any case, an addendum would be
placed as part of this agreement.


This Agreement will be binding on the parties hereto, their principals, employees, representatives,
agents, assignees, consultants, heirs, and successors. Essentially, the spirit of this agreement is
one of mutual trust and confidence and reliance of each party to do what is fair, honest and equitable.
 International law and the commercial code shall apply where applicable, and that in the event of such
circumvention, either directly or indirectly, the circumvented party shall be entitled to a legal monetary
 penalty equal to the maximum services fee it should have realized from such transactions. Note:
The NCND violation is very serious. This agreement shall include the payment of the full amount
of remuneration the Party would have received had they been involved with completing the
transaction and shall include any and all court costs and attorneys fees.

 Page 2 NCND Agreement.






X_______________________________ O./__________________Fax:_______________




X_______________________________ O./__________________Fax:_______________







Address: __________________________________________


Company: Global Equipment and Finance Co. 


X________________________________                                          DATE:________


2551 Pine Bluff Dr. Dallas TX

O/FX: 214-321-9044 / Fx 214-321-5304 





Project  _________________________________. DATE: ___________



 Office:                                             Fax: 


 Office:                                             Fax: 


Re: List of Potential Client(s) by signed NCND Agreement. . 



______________________ registers the Following  list of potential Clients. Please acknowledge BY SIGNATURE BELOW.



                   NAME                              ADDRESS                       TEL/FAX


















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Last modified: Thursday October 26, 2006