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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

* Name of Company:
Address:
* City/Town: * State: Zip:
* Phone #: Fax #:
Website:

Contact Information

Contact Person
Name: Title:
Office Phone Number: Cell #:
*E-Mail:

Are you the Decision Maker for Funding?:

Y N
If no, Contact Person Name:
Phone #
Cell#
Email

Business Information

Business Structure

Sole Proprietor: Partnership LLC Corporation

Specialty Corp

Y N
If yes please list

Does your business require you to be licensed?:

Y N
If yes please, explain:

Year Founded:
Industry:
Annual Sales:
Annual Profits:
Profit Margin Per Sale:
Number Of Employees:

Funding Request

PO: Inventory: Equipment: Accounts Receivables: Construction: Insurance: Medical:
Other:
Funding Amount:
Needed By:

Is This A Funding Emergency?

Y N

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

Y N

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

Y N

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

Y N

What is the funding to be used for?:

Do you have pending contracts?:

Y N
If yes list contract and size

Credit History

Company Credit Rating Score:

Bankruptcy:

Y/Year N

Have you ever been turned down by a bank?:

Y N
If yes how long ago and why?:

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

Y N

Do you have investor already in place?:

Y N
If Yes, what percentage do they own%

Do you have stockholders in the company?:

Y N
If YES, please list and give percentages:

Business Model

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

Y N

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

Y N

If your business a combination of B2B and B2C?:

Y N
If yes, what is the percentage of sales from you B2B clients?:

How many clients do you currently service?:
What is the average time-line to producing goods or services before you bill?:

Assets

Current Accounts Receivable Under 90 Day Amount:
Current Inventory:
Owned Equipment Value:
Commercial Real Estate Value:
Commercial Real Estate Value:

Liabilities

Accounts Payable Amount:
Equipment Lease or Loans:
Bank Loan Amount:
Monthly Rent/Morgage:
Taxes including payroll currently owed:
How far out are taxes including payroll are in arrears:

Bank Liens:

Y N

Tax Liens:

Y N

Equity Owed:
Pay Off Date:

Accounting & Billing

Accounting: Which Accounting Method Do You Currently Practice?:

Cash Accounting Accrual Accounting

Billing Methods:

Progressive Billing:
Pre-Billing
Accounts Receiving Invoicing
Advance Payment
Consignment Billing
Contingency Billing
Credit Cards

How Often Do You Invoice?

Daily: Weekly Bi-Weekly Monthly

Average Receivable Outstanding?:

Less than 30 Days
30-45 Days
45-60 Days
60-90 Days

How many clients currently out?:
Less than 30 Days
30-45 Days
45-60 Days
60-90 Days

Do you have one single client that is 50% or more of your total sales?:

Y N
If yes who and what percent?

Do You have a Billing Audit Trail in place
(Purchase Order, Invoice, Proof of Delivery):

Y N

If NO would you like one?

Y N

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.
Y N
If No, how long will it take to provide this information?

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.

Your Broker is:

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

Enter The Characters In The Box

*

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 …