Business Credit Application You win the contract, we fund it

Transcription

1 IMPORTANT INSTRUCTIONS: Mobilization Capital Gov Contract Financing, LLC 6608 Brynhurst Drive Tucker, GA wwwmobilizationcapitalcom Business Credit Application You win the contract, we fund it A Please complete on computer and print/sign/scan/ back to get_funded@mobilizationcapitalcom or your referral source Initial each page B Include application submission: 1 Govt contract copy and copy of Notice to Proceed 2 Previous 2 years of personal and business tax returns if applicable 3 All supplier/sub-contractor invoices or quotes if applicable 4 Copy of business formation docs (articles of incorporation) 5 Copy of driver s license Referral Source/phone #: Click here to enter text Last: Primary Owner Info: Title First: Middle Initial: Own 100% of business? Yes No Personal Address (residence): Social Security Number: Previous Personal Address (if different within last 2 years): Page 1 of 5

2 Company Information Name of Business: DBA?: Main NAICS description (main business activity): In Business Since: Business Business incorporated in which US State?: DUNS: CAGE: Tax ID #: SBA 8a Certified? Yes No 8A Certification Date: Other small business categories (check all that apply): Veteran SDVOSB Woman Owned Minority HUB Zone Other (please list) Legal Form Under Which Business Operates: Corporation LLC Page 2 of 5

3 Government Contracting References (List current govt contract requiring funds in first block) Agency Name: Agency Name: Contract #: Contracting Officer name and contact info: Contract #: Contracting Officer name and contact info: Date Awarded: Date Awarded: Trade References (Include at least main supplier) Phone: Phone: Phone: Account Opened Since: Account Opened Since: Account Opened Since: Current Balance: Current Balance: Current Balance: Banking Information: This is the bank account the government will deposit your contract payments into Usually it is the account that has been registered under SAM (System for Award Management) Financial Institution Name Routing Number Account Number Banker Contact Does Bank allow Sweep Account? Page 3 of 5

4 Financial History Questionnaire: Negative financial history does not automatically disqualify you from Mobilization Capital funding We understand what it s like to run a small business and/or having a negative personal circumstance However, your honesty with your situation helps us establish our trust in your ability to re-pay Have you ever OR do you have: Yes No Changed named or used another name? (if yes -- include old alias and jurisdiction of change) Filed for Bankruptcy? (if yes include discharge date and jurisdiction) Defaulted on a debt within the last 5 years? (if yes -- include creditor name, date and status) Have outstanding current debt over $2,00000? (Exclude auto and residential payments) Have outstanding Liens? (if yes -- include date, amount and status) Have outstanding Judgements? (if yes -- include date and jurisdiction) If you answered Yes to above questions, please provide details: Page 4 of 5

5 Contract Specific Information (please attach copy of contract to this application): Contract # Govt Agency/Customer name Period of Performance dates or final delivery date requirement Total contract value (base year only) Answer Additional Comments Use of Funds (provide breakdown of costs if applicable) Consent statement: I/we hereby certify that the information contained herein is complete and accurate This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended and risk of borrower Furthermore, I hereby authorize the Mobilization Capital to contact all parties listed in this application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein In connection with my loan application, I authorize Mobilization Capital to obtain a background report about me I acknowledge the background report may contain information concerning my past performance of on government and commercial contracts, credit history and standing, general personal character and reputation, personal characteristics which will be used to assess the risk on funds loaned The types of information that may be obtained include, but are not limited to: social security number verification, criminal records check, verification of previous government and commercial contracts/performance, and current landlords, verification of employment, and credit reports I/we also hereby authorize Mobilization Capital or our affiliates ConServ Capital and Conserv Business Leasing LLC to secure a credit report from time to time in connection with the extension or continuation of credit or the collection of debts resulting therefrom Debtor further agrees to the release of credit information, including the reporting of credit history to credit reporting agencies, consistent with the Fair Credit Reporting Act 15 USC 1681, et seq, as amended This authorization shall be continuing without expiration A photocopy or facsimile copy shall be given the same effect as the original Signature Date Printed Name: Page 5 of 5