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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
This FORM is not intended for use as a credit or bank application. The
information from this FORM is to provide Global Equipment Purchase, Loan,
Venture Capital, Joint Venture, Debt refinance, and/or 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 ___ Description: 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 ___
26).
Management Résumes available?
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) Unknown 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 Yes ___No ___ Comment:
37). Upon receipt of acceptable loan terms and/or if necessary, are you prepared
to furnish a performance bond 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
C). CURRENT FINANCING – 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. ____________________________ 2._____________________________ 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 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
Your Questions / Comments: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
STATE OF TEXAS. COUNTY OF DALLASPROPRIETARY TRADE SECRETNON-CIRCUMVENTION, NON DISCLOSURE ‘NCND’ AGREEMENT.
KNOW ALL MEN BY THESE PRESENTS: This agreement is made in
connection with current business transactions/discussions as Project Description / Requirement________________________________________________________
Groups involved with the
parties listed or registered should be responsible to this NCND
This
agreement is reciprocal between the signatories concerning the privileged
information and
Nor shall either party disclose or
otherwise reveal to any third party, any confidential information
This Agreement will be binding on
the parties hereto, their principals, employees, representatives, Page 2 NCND Agreement. THE FOLLOWING PARTIES ACCEPT THE TERMS OF THIS AGREEMENT:
Name: Company:
X_______________________________ O./__________________Fax:_______________
Address:_________________________________________
X_______________________________ O./__________________Fax:_______________
Name: Company: X____________________________________O/FX:______________________DATE:_______
Address: __________________________________________ Company: Global Equipment and Finance Co.
X________________________________ DATE:________
2551 Pine Bluff Dr. Dallas TX O/FX: 214-321-9044 / Fx 214-321-5304
REGISTRATION OF CLIENTS
Project _________________________________. DATE: ___________
TO: Office: Fax: FROM: 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
1.)
2.)
3.)
4.)
5.)
ACCEPTED:_______________________________________________ |
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