intakeform

Project Name

Project Type

Project Location*

Whatis the total project need?*

Are you looking for Debt, Equity, or Both

Debt

Equity

Both

Do you have anyone else in place to provide either debt and/or equity? (If yes, please explain).

How much have you spent to date?

What amount do you have for a cash down payment?

What are the sources of funds for a down payment?Paragraph

Is there a lien currently on the project?

What is your exit strategy?

Company Legal Name

State of Incorporation

Country

Registered Address

Domiciled Address

Entity Type (LLC, Limited Partnership, INC., Etc.)Short answer

Principal(s)/Managing Member(s)

Is there any pending litigation of any form involving a shareholder?

Have you utilized international capital before? If so, where?Paragraph

Do you owe the IRS?

Have you declared bankruptcy? If so, when? Paragraph

Has it been discharged?

This submission form should be completed by the borrower(s), with summary details for each topic shown.