Trillion Dollar Funding Request Form

The following request form is NOT an Application for Funding and is used as the first step in qualifying a business or company for financial and funding options available through our Funding Network.

Required fields have a * beside them

Company Name






Contact Information

Contact Person



Are you the Decision Maker for Funding?:




Business Information

Business Structure

Specialty Corp

Does your business require you to be licensed?:







Funding Request





Is This A Funding Emergency?

Are You Just Shopping Around For Funding At This Time?:

Have you ever worked with asset based/privatized funding before?

Do you know the difference between
asset based/privatized financing verses traditional financing?:


Do you have pending contracts?:

Credit History


Bankruptcy:

Have you ever been turned down by a bank?:

Are you currently getting funded by a private funding company?:

Do you have investor already in place?:
If Yes, what percentage do they own%

Do you have stockholders in the company?:

Business Model

Is your buiness model structure to be a Business to Business (B2B):

Is your business structured to be a Business To Consumer (B2C):

If your business a combination of B2B and B2C?:



Assets






Liabilities







Bank Liens:

Tax Liens:



Accounting & Billing

Accounting: Which Accounting Method Do You Currently Practice?:

Billing Methods:







How Often Do You Invoice?

Average Receivable Outstanding?:



How many clients currently out?:




Do you have one single client that is 50% or more of your total sales?:
If yes who and what percent?

Do You have a Billing Audit Trail in place
(Purchase Order, Invoice, Proof of Delivery):
If NO would you like one?

Paperwork Requirements

Can you provide the following information to our funding source upon request?: Executive Summary
Articles of Incorporation or Legal Company Papers
Photo IDs of Owners of 20% or More
P& L’s (profit and loss statement)
Balance Sheet
Client List
Aging Report Both Accounts Receivables & Accounts Payable
Recent customer sale (purchase order, invoice and proof of delivery) Please provide any other supporting documentation as well.




Broker Information & Funding Fees

Upon Submitting this Funding Application you are agreeing to allow Trillion Dollar Funding & Prosperity Funding Solutions to present this information on your behalf to our funding resources. Trillion Dollar Funding does not charge or collect up front broker fees.

Funding Fees: Our funding sources may require and charge certain fees in order to provide funding. These fees are set and determined by the funding source we connect you with.


(Please be advised none of our funding sources provide equity, seed money or 100% Financing or Funding)

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Thank-You for taking the time in filling out our request form, we will do our best at contacting you with-in 48 hours unless it's a holiday or weekend. If you should have any questions or need help with filling out the request form please e-mail us at: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

All information is kept confidential.

… SERVICE IS OUR PURPOSE … MONEY IS OUR INVENTORY …