Quick Information Form Note: Downloadable (DOC, PDF & TXT) versions of this form can be found on our website: www.FDPcapital.com If you are not using a computer, please Type or PRINT your answers using block letters and please attempt to answer each question. (You may use “n/a” for those questions that do not apply to you) Today’s date: _____/_____/20____ 1. Name of Company (or individual) applying for funding, with COMPLETE mailing address. (Note: if you are a finder or broker, please note your contact information in Block #17 below, as our lenders/investors will want to talk to the principals for the project directly) Legal Name of Company: Name of Principal: Business Address: Phone: Fax: Cell: E-mail: Project Name: Project Website: Location of Project: 2. Company owners and percentage of ownership. (5% or greater owners) (Note that short bios for key management personnel, must be included here. Complete resumes/CV’s should be available and can be forwarded as separate documents) 3a. Type(s) of funding you are looking for and why this type of funding (debt, equity, private placement, etc.)? 3b. Have you tried to obtain this funding, or possibly a Letter of Credit, from your own bank? 3c. Are you currently working with any other potential funding sources, to obtain the funding you need for your project? 3d. Do you need any special loan/investment terms? (Reserve interest, line of credit, financing of fees and/or points, etc.) 4a. Brief description of the company. 4b. Number of years in business. 4c. Type of business entity. (DBA, GP, LP, LLC, Corp, etc.) 5. MII - Minimum Initial Investment: The amount of funding you are requesting? (Note: Ask for the full amount that you need. Asking for too little could be counter productive.) 6. LOI - Length of Investment: How long will you need these funds? 7. ROI - Return on Investment: What do you anticipate the total return on the investment will be? 8. What forms of collateral will you be using? If none, how do you propose to minimize the risk to our lenders/investors? 9a. How much of your own money do you currently have at risk in association with this project and can you provide proof of these personally invested funds? (Note: The reason this question is being asked, is that most of our investors/lenders want to know how much "skin," you have in your project. If you are not willing to put your own money into your own project, why should they want to. Note that "sweat" equity will not suffice as the only investment you have in your project.) 9b. How much money do you currently have that you can put into your project, if you had to, for possible closing costs? 9c. Would you be willing to pay travel expenses for an on site visit to meet face-to-face to look at and discuss your project? (Note: The reason this question is being asked is that we don’t want to waste your or our investor’s time. We need to make sure that we are working with viable projects and with clients who are serious about meeting their project goals, therefore we may need to visit your project site and meet with you in person.) 9d. How long have you been looking for funding for your project? 10a. How would you prefer to repay our lender/investor? (Please provide a proposed repayment plan including any options here) 10b. Briefly describe how our investors/lenders will benefit from funding your project. 11. If you plan to use Real Estate as collateral, you MAY be asked to provide an appraisal no more than 6 months old. 11a. What kind of real estate collateral will you be using (if any)? 11b. Do you or your company own commercial real estate? 11c. Own publicly traded stock? 11d. Does your company have authorized shares? (If so, what percentage would be available for potential investors?) 11e. Have cash reserves? 11f. Have monthly MasterCard and Visa Card, etc. merchant business coming in? 11g. Own your own equipment? 12. What is your company's annual revenue? (Note: You MAY need to provide business or personal tax returns to support revenue claims and list any third parties attached to your project; or who will be due any payments or commissions.) 13. All companies, even Fortune 1000 companies, typically pay a fee as part of the funding process (see www.loanpricing.com). This fee may be called a due diligence fee, application fee, retainer, etc. Do you understand that you may be asked to pay a fee as a standard part of the lending process? 14. Do you have a Business Plan and Financial Statement prepared for your project? (Note: We cannot process a Funding Request without an up-to-date Executive Summary, Business Plan and Financial Statement. The Financial Statement can be a separate attachment or incorporated into the Business Plan. Either method is acceptable.) 15. Are there any "skeletons in the closet" (bankruptcies - if discharged, note date; foreclosures, criminal convictions, FTC or SEC fines or settlements, pending civil litigation, etc.) that we need to be aware of prior to submitting your Funding Request to our investors/lenders? (Note: An affirmative answer to this question does NOT preclude your Funding Request from being submitted to our investors/lenders; but PRIOR disclosure is a requirement.) 16. Additional Comments - Is there anything else you feel we need to know that might help us to help you to obtain the funding you need for your project? (Note: “None” is a valid answer.) 17a. Who is your FDP Capital authorized Broker or Representative (if any)? Rep. Name: Address: Phone: Fax: Cell: E-mail: Website: 17b. Number of broker points allotted to this broker (if any): Note: Broker points are only allotted when you have a prior agreement to pay a Broker or Finder representative for helping you obtain financing. FDP Capital LLC does not receive any portion of funds that you allot to Brokers or Finders as points. When completed, you may print and fax this form to: Fax: 1- 215.252.5404 Or You may save and e-mail* the completed form to: funding@fdpcapital.com *Please remember to include your “Project Name” in the subject line of your e-mail and attach any associated documents; Executive Summary, etc. Note: Downloadable (DOC, PDF & TXT) versions of this form can be found on our website: www.FDPcapital.com . 67 WALL STREET SUITE 2211 NEW YORK, NY 10005 Phone: (212)709-8228 Fax: 215.252.5404 www.FDPcapital.com