Broker / Intermediary Application


Thank you for visiting the Intrepid Private Capital Group. Please complete the Application below so that we may consider your Project for funding.

Requirements
Confidentiality Statement
Intrepid fully appreciates the need to handle your business planning documentation with the utmost care and consideration of the private and confidential nature of its contents. One of the values most often expressed as essential by our Clients, of the services we provide, is the absolute discretion associated with our relationship.

As such, your documentation - and every detail of your financial affairs - will be shared on a strictly need-to-know basis. Be assured, that a hallmark of the unique and valuable services we provide includes our appreciation for the highest degree of privacy and confidentiality associated with commercial International finance.


Project Details
Project Name:
Project Location:

Company Name:
Company Website/URL:

Amount seeking in USD (Minimum US$1M):
$

Use of Proceeds:

(IE: Inventory, Purchase Orders, Working Capital)

Business Sector:
Type of Capital:

Are you able to secure the loan? If yes, how?
Do you have equity in the project?

Brief description of the project:
Do you have experience in the field?

What is the market for your product/project?

Principal
Principal(s):
     
     
     
Business Name:

Address:
(Street Address)

(Suite, PO BOX, etc)
Telephone:
City:
Cell Phone:
State/Province:

SKYPE Address:
Country:

Email:
Postal Code:

Broker's Contact Information
Broker:
     
Business Name:


Address:
(Street Address)

Address:
(Suite, PO BOX, etc)

Telephone:
City / Town / Locality:
Cell Phone:
State/Province:

SKYPE Address:
Postal Code:
Email:
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
It is important to include:
Financial Data expressed in US Dollars, CV's (for the Principal and Management Team of the Project)

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 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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