Broker / Intermediary Application


Requirements
Confidentiality Statement
Intrepid Private Capital Group is committed to maintaining the confidentiality, integrity, and security of personal information about our current and prospective customers. We will never share or sell your information with any 3rd party. Your information will only be used as necessary by Intrepid Private Capital Group office and potential Funding Sources as necessary and with your full disclosure and awareness. You can be sure that we will do everything possible to keep your information secure.

Project Details
Project's Legal Name
Project Location
Business Name
Business Sector
Type of Capital
Precise Amount of Capital (USD)
$
Enter USD Only - Format: x,xxx,xxx.xx
Use of Proceeds

(IE: Inventory, Purchase Orders, Working Capital)
Business/Project URL

(IE: http://www.businessproject.com)

Principal's Contact Information
Principal's Full Name
  
  
  
Address
(Street Address)
(Suite, PO BOX, etc)
Telephone
City
Cell Phone
Fax
State/Province
Postal Code
Email (yourname@email.com)
Country

Broker's Contact Information
Full Name
  

Business Name

Address
(Street Address)
(Suite, PO BOX, etc)
Telephone
City
Cell Phone
Fax
State/Province
Postal Code
Email (yourname@email.com)
Country

About the Client
How did you acquire this client?
When did you acquire this client?
How long has the client been in business?
How is the client organized?
How long have you known the principal(s)?
How long has this client been seeking funding?
Has this client ever declined any funding offers? If yes, please explain below:
Are your clients aware of and prepared to pay loan costs?
YES     NO

Business Plan
How would you like to send us your business plan?




How did you hear about us?
(optional, but your input is really appreciated)
How did you learn about our company?
If you were referred by an Intrepid contact,
please let us know who:
If you heard about us somewhere else that was not listed,
please let us know where:

Terms of Agreement
By submitting this form, you acknowledge that you have reviewed the Terms of Site Use and have thoroughly reviewed the entire Intrepid Private Capital Group website. You also confirm that you understand that the world of private, commercial, international finance is extremely fast-paced. We will confirm receipt of the project documentation within 24 hours. If accepted by this office, your Project will be presented to one or more Private Funding Sources. At this point, Intrepid Private Capital Group MAY extend an invitation for you to meet with us for the purpose of arranging Funder introduction(s) either by telephone conference or in person. Intrepid Private Capital Group will make every effort on your behalf to arrange this, but cannot guarantee that your Project will qualify for an invitation to such a meeting. This form is the intellectual property of Intrepid Private Capital Group, LLC. ALL content and submission data is kept strictly Confidential and Proprietary.

        
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