Debt Intake Form

By completing the form below our team will be alerted of an debt or financing opportunity. Once completed we will begin the initial due diligence and schedule a meeting with you to review the project. Thank you again for giving Deal Exchange the opportunity to work with you. If you have questions or need support please email; info@dealexchange.com.

Project Information

Your Name(Required)

First Last

Your Email(Required)

Project Name(Required)

Project Type (Ex: Real Estate)(Required)

Project Location(s)(Required)

What is the maturity level of the business?(Required)

What is the total project need?(Required)

Are you looking for debt, equity, or both?(Required)

Debt

Equity

Do you have anyone else in place to provide either debt and/or equity?(Required)

Is this project a development or expansion?(Required)

If expansion, do you have patents?

How much have you spent to date?(Required)

What amount do you have for a cash down payment?(Required)

What are the specific source(s) of funds for a down payment?(Required)

How many total investors are there?(Required)

Is there a lien holder currently on the project?(Required)

Yes

Who is the lien holder?

What is your exit strategy?(Required)

What is the maturity level of the business?(Required)

Do you have any debt, if so how much and with who?(Required)

Have you engaged brokers to work on this project or something similar?(Required)

Is there someone in your organization who is willing to personally guarantee this facility?(Required)

Does your current monthly cash flow cover current debt?(Required)

Borrower Information

Company Legal Name(Required)

Company's Registered Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Entity Type(Required)

Principal(s)/ Managing Member(s)(Required)

Principal(s)/ Managing Member(s) Emails(Required)

Borrower Disclosures:

1. Have you ever filed personal bankruptcy or served as an officer in a company that declared bankruptcy?(Required)

2. Are you subject to taxes or credit obligations past due?(Required)

3. Have you, your company, or any shareholders subject to or have been involved in any lawsuits or outstanding judgments by any person, company, or organization?(Required)

If yes, explain.

4. Are you under indictment, probation, or parole, or ever been charged or convicted for any criminal offense other than aminor motor vehicle violation?(Required)

5. Are you a representative of a political party, a campaign, a candidate, a public official or foreign political official or an immediate family member of such an official, or a business entity formed by or for the benefit of any public official?(Required)

If yes, please state name, relationship, & position of official

6. Do you have any tort claims?(Required)

If yes, please explain

7. Do you have any deposit accounts or securities accounts?(Required)

If yes, please explain

Please provide Attorney's Information (if applicable):

Attorney Name

Attorney Email

Company Legal Name

Registered Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Documents needed to review for determination if the project is a potential fit

Executive Summary

Borrower Resumes

Proforma

Construction or Project draw schedule with dates

List all brokers being compensated and attach any agreement

File Upload

Drop files here or

Max. file size: 128 MB.

LOC Disclosure

The undersigned certifies that I intend to apply for a private line of credit (the “LOC”) in the manner indicated in this project submission form and certify that everything stated in this submission form and on any attachment or supporting document is correct. I understand that the Lender decided upon may keep this application whether or not it is approved. I understand that Lender is not obliged to disclose the reason(s) for such disapproval. I certify that the private LOC being applied for will be used for business purposes.

Name of Authorized Signer (please print)(Required)

Authorized Signature(Required)

Who referred you to Deal Exchange?(Required)

Name of Person if Not Listed Above:(Required)

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