INQUIRY FORM. Please fill out the following brief inquiring form and let us know how we can help you. A representative will be in touch with you soon.

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1 INQUIRY FORM FINANCIAL SOLUTIONS FOR EXISTING BUSINESS Please fill out the following brief inquiring form and let us know how we can help you. A representative will be in touch with you soon. CONTACT NAME:.. CONTACT No: TIME... BUSINESS NAME:... DATE OF INCRPORATION: CITY.. BY WHAT DATE DO YOU NEED FUNDING: Does your company hire sub contractors in order to provide your service or produce? Yes No If, yes explain briefly... Does your sub contractor place liens on the job?.. Jugements Liens Law Suits Do you have any outstanding loans if yes where? Balanced Owed:.. Are receivables/services pledged as collateral? No Yes Total Receivable outstanding.. Do you have any current pending tax problems No Yes Tax Balance Owed Do you have a payment plan? No Yes Monthly payment..

2 COMPANY INFORMATION. ACCOUNT RECEIVABLE/SERVICES FINANCE APPLICATION DATE SUBMITTED:. COMPANY NAME:. TYPE OF BUSINESS:.. DIRECTORS. PRESENT ADDRESS:. CITY: COUNTRY:. CONTACT PHONE No: FAX OTHERS:. STRUCTURE: CORPORATION LIMITED Co SOLE PROPRETORSHIP YEAR IN BUSINESS:. PARTNERSHIP DATE OF INCORPORATION: TIN VAT No:.. ARE YOUR CUSTOMERS DOMESTIC FOEIGHN

3 SUPPLIER ACCEPTANCE FORM CAMPANY NAME (Supplier):.. ADDRESS:. SUPPLIED TO: :... INVOICE AMOUNT:. INVOICE NO: L.P.O No. Dated:. DELIVERY NOTE: Dated LESS RETAINAGE:. INVOICE WILL BE PAID ON OR BEFORE:. PAYMENT WILL BE REMITTED TO:. BY: TITLE... FACTORING FEES: SIGNED FOR AND ON BEHALF OF.. By the said VENDOR, Name. Title Sign:. Date *Terms and conditions apply overleaf*

4 FOR WORK PERFORMED/ SUPPLIED AT:... We would like to confirm and warrant the following in reference to the above subject account: The above invoice (s) are correct and will be paid in accordance with the terms regardless of any and all provisions of any and all contracts to the contrary, if any; All of the goods and / or services in connection with the above invoices have been received in full and/or satisfactorily completed and accepted by you and such invoices will be paid in full by you, without any claims, offsets, deductions, credit or returns or otherwise, including, but not limited to, whether the sellers provider of such goods and/or services is or may be obligated or indebted to you, for any reason whatsoever. The quality and condition of all the goods and/or services in connection with the above invoices or acceptable and such goods or services have been sold to you as a BONA FIDE Sale. Acceptance by you constitutes acceptance of the goods and/or services regardless of any provision of the primary contract or subcontract to the contrary and regardless of any subsequent rejection of the goods and/or services by you or the owner of the goods or otherwise None of the goods provided for in the above invoice(s) are consignment sale, guaranteed sale or Exchange sales SIGNED FOR AND ON BEHALF OF.. By the said SUPPLIER, Name. Title Sign:. Date In the presence of Name. Title Sign:. Date.

5 CLIENTS INFORMATION NAME OF THE CLIENT: ADDRESS:.. PERSON TO CONTACT. TITLE CONTACT... Kindly enclose the following Current Account Receivable/Services Aging. A List of Customers you wish to factor if more than 5. By and in providing the information requested, the Applicant warrants that he/she/it has read and understood all the terms and conditions constituent of this entire agreement and more particular as below mentioned: 1. Applicants understanding to LEVEL 5 ASSOCIATES LTD intends to rely on the foregoing information in determining whether to enter into a factoring/invoice discounting program. 2. That the foregoing information may be incorporated by reference into an agreement between applicant and LEVEL 5 ASSOCIATES LTD 3. Any failure of applicant to disclose truly, completely and correctly the information requested my constitute a breach of any such agreement 4. LEVEL 5 ASSOCIATES LTD has not by requesting the completion of or accepting this application form, committed to make or implied an intention or commitment to enter into a factoring/invoice discount program with applicant. 5. The Applicant acknowledge that he/she/it has retained a copy of this application 6. The Applicant herby authorizes LEVEL 5 ASSOCIATES LTD (officer, employee, or other representative thereof) to visit and inspect any properties of applicant, to discuss applicant and its affairs, finance, and accounts with, and be advised as to the same by applicant s officers, employees, and an independent public accountant, all to such reasonable extent as LEVEL 5 ASSOCIATES LTD may deem fit.

6 7. The Applicant hereby authorizes its clients, suppliers, customers, lenders accountants, principal s officers and attorneys to provide LEVEL 5 ASSOCIATES LTD (and any officer, employee or representative thereof) with such information about applicants and its affairs, finances and account as LEVEL 5 ASSOCIATES LTD may request. The applicant also authorizes each such person and firm to accept copy of this authorization in its original. 8. The Applicant provides this information and authorization on the basis that LEVEL 5 ASSOCIATES LTD seeks such information in utmost good faith in connection with the factoring/invoice discount application.

7 We look at the following factors when we consider pricing your dial: Annual Sales volume Credit worthiness of your clients Average invoice size Domestic or International Payment Terms A typical charge for a 30day invoice will be 6% to10%. The prime plus method is used by larger factors while the discount method is used by smaller factors. Usually the Prime Plus method produces lowers rates than the discount method. The Prime Plus method has two fees, the first fee is a one time fee per invoice called the FACTORING FEE and is changed on the gross amount of the invoice. The second fee is the INTEREST change on the money advanced per invoice based on your advance rate. The interest charge begins on the day we advance your fund for that invoice. The interest charge is a percentage over the prime rate that has been agreed upon prior to signing and factoring agreement.

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