This Submission Form should be completed by the borrower(s) with summary details for each topic shown. All information must be completed.

Personal Information

• Name     Email Address     Phone Number

• ---

Project Information

• Project Name     Today's Date
• Project Type
• Project Location(s)
• What is the total project need? ($)

• Are you looking for debt, equity, or both?

  Debt     Equity
• Do you have anyone else in place to provide either debt and/or equity?
• How much have you spent to date? $

• Do you have 20% liquid Cash for down payment?

  Yes/NoSelectYesNo    $
• What are the sources of funds for a down payment?
• Is there a lien currently on the project?
• What is your exit strategy?

• Borrower Information

• Company Legal Name     State of incorporation     Country
• Registered Address
• Domiciled Address
• Entity Type (IE: LLC, Limited Partnership, Inc.)
• 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?
• Do you owe the IRS?

• Have you declared Bankruptcy?

  If so, when?    Discharged?