Debt Lending Application

Name *

First Last

Email *

Date

dd-MMM-yyyy

Phone *

Fax (personal or business)

Linked In Profile URL

Address

Street Address Address Line 2 City State/Region Postal Code

Country

Legal business name

Official Business Website URL

Business Address (if separate from personal address)

Street Address Address Line 2 City State/Region/Province Postal / Zip Code

Country

Date Established

dd-MMM-yyyy

All D/B/A, fictitious & assumed names:

Type of Business:

TAX ID/EIN

If yes, has lien been filed?

If yes to taxes past due, please list type, quarter/year and amounts

What is the purpose of funds to be generated from funding

Dollar amount of receivables now open

Date of aging

Approximate Number of Customers

Terms of Sales

Average Monthly Sales

Amount you intend to fund on a monthly basis

If yes to funding receivables, with what company?

If yes, pledged to whom?

If yes to commercial loans, please describe them:

List any and all associated entities, affiliates and subsidiaries

How did you find out about us?

Referrer Name

First Last

Referrer Company

Referrer Phone

UNITED STATES BUSINESS REVENUE ANNUALLY

USD

GLOBAL BUSINESS REVENUE ANNUALLY

If you do, value of real estate property

Do you have large purchase orders from high-profile vendors (IE: $50K purchase orders from Walmart for your product?) If you operate with P.O.’s please explain your situation

Pitch Deck/Brochure/Executive Summary/Other

Drag & Drop (or) Choose File

Balance sheet/P&L/EBITDA

Drag & Drop (or) Choose File

Supporting Document(s) or Zip 1

Drag & Drop (or) Choose File

Supporting Document(s) or Zip 2

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I/We have been told and do understand that the submission of this application for financing with 2030 Ventures, Global Capital Network or lending partners (“Lender”) does not mean that Lender will fund or provide any financial services whatsoever.

I/We further have been told and do understand that approval to purchase receivables may come only after Lender approves said application and the invoices/accounts offered are approved in accordance with the terms of Lenders Accounts Receivable Purchase and Sale Agreement.

I have been advised that after my written request, made within a reasonable time, I have the right to receive a complete and accurate report of the nature and scope of such procedures in accordance with Section 606(b) of the Fair Credit Reporting Act.

The above statements are true and accurate to the best of my information and belief. This serves as my permission for the release of any information regarding this application for the purposes of credit and personal background investigation to Lender.

Verification Code *

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Debt Lending Application

BUSINESS INFORMATION

FINANCIAL INFORMATION

COLLATERAL

ATTACHMENTS & SUPPORTING DOCS TO UPLOAD

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