FINANCING PROGRAMS APPLICATION Dated: June 20, 2011 The Business Consortium Fund, Inc. 305 Seventh Avenue, 20 th Floor New York, NY 10001 Attn: Financing Programs Tel: 212-243-7360 Fax: 212-243-7647 info@bcfcapital.com
INSTRUCTIONS Applicants must meet the following minimum eligibility requirements in order to apply for BCF assistance: (1) Applicant is certified as a minority-owned business by the NMSDC or one of its affiliated regional councils, and (2) Applicant is doing business with a national or local NMSDC corporate member. For purposes of this Application, doing business means either currently selling products or providing services to a NMSDC corporate member or having sold products or provided services to a NMSDC corporate member within the last twelve (12) months. The application should be completed as follows: Sections A (Business profile) and F (certifications): must be completed by all Applicants. Section B: complete and submit requested documents only if applying for a direct loan. Section C: Complete and submit requested documents only if applying for factoring financing (please note that the BCF provides factoring financing with a partner requiring Applicant to complete separate application form in Section C). Section D: Complete and submit requested documents only if applying for accounts receivable financing (please note that the BCF provides accounts receivable financing with a partner requiring Applicant to complete separate application if the partner moves forward with the financing). Section E: complete and submit requested documents only if applying for a loan guaranty or loan participation under the BCF Loan Guaranty/Participation Program ( LGPP ). Under the LGPP, the BCF may guaranty or participate in up to 75% of a loan made to Applicant by a bank or other qualified financial institution. Applicant may apply for multiple programs. The BCF Factoring, Accounts Receivable and LGPP programs operate with third-party banks or other lenders. Therefore, Applicant must authorize BCF to share the information in the Application with such potential thirdparties in order to process the Application. Applicants may be required by such third party to complete a separate application for financing. Completed Applications, together with other requested documents and any applicable fee, should be submitted to: The Business Consortium Fund, Inc. 305 Seventh Avenue, 20 th Floor New York, NY 10001 Attn: Financing Programs Or info@bcfcapital.com 2
SECTION A: BUSINESS PROFILE 1. Name of Applicant (Company name): 2. Address (Attach sheet listing other business locations): 3. Contact name: Title: Phone: E-mail: *provide name and contact information for Applicant s CEO if CEO is not contact. 4. Company website: 5. Currently NMSDC certified: Yes No Certifying Regional Council: 6. NMSDC MBE Class Status: As of its last completed fiscal year-end, Applicant revenues were (check one category): Revenue< $1 million (Class I) Revenue between $1million - $10 million (Class II) Revenue between $10million - $50 million (Class III) Revenue >$50 million (Class IV) Check if Applicant is: Corporate Plus certified under Growth Initiative 7. Minority status: African American Hispanic American Asian American Native American (Asian American includes Asian-Indian and Asian-Pacific individuals) Provide details if any of the Applicant s principal officers or the majority/controlling stockholder, partner, member or owner are not citizens of the United States. 3
8. Name of NMSDC national or local corporate member Applicant either (i) is selling products or providing services to, or (ii) has sold products or provided services to within the last twelve (12) months: Name Corporate Member Revenue from Corporate Member w/in last 12 months Name, phone number of contact at Corporate Member 9. Has the Applicant, any of its directors, or any of its stockholders owning 20% or more of its stock ever received financial assistance from the BCF? Yes No 10. NAICS Code: 11. Federal Tax ID number: 12. Type of business (include description of products/services): 13. Legal structure: C-Corporation S-Corporation LLC Partnership Proprietorship Other (explain): 14. Management Year Company founded: Number of years in business with current owners/management: 4
15. Applicant Employment: Number of current employees: Employees retained if financing received: New jobs created if financing received: 16. How did you hear about the BCF? BCF Website NMSDC Website Council Corporate Member Trade Fair Other (explain) 5
SECTION B: DIRECT LENDING PROGRAM Complete this Section and Sections A and F and submit requested documents and fee only if applying for a direct loan. 1. Amount of financing requested: $ 2. Type of loan being requested: Term Line of Credit 3. Use of Proceeds Working Capital $ Equipment $ Inventory $ Business Acquisition $ Furniture/Fixtures $ New Product Devel. $ Debt Refinancing $ Other $ Please submit a separate schedule marked as Schedule B-3 providing a detailed listing of the equipment, machinery, furniture, fixtures and leasehold improvements and/or a description of the business acquisition, debt refinancing, new product development or the other use of proceeds. 4. Provide the names of all the Applicant s directors and officers (indicating all positions held by such person). 5. Provide the names of all owners of twenty percent (20%) or more of the Applicant s stock along with the percentage of their ownership interest. 6
6. Submit a separate schedule labeled Schedule B-6 setting forth for each director, officer and 20% owner, the number of years each has owned a business in this or similar industry and the number of years they have managed a business in this or similar industry. 7. Submit a separate schedule labeled Schedule B-7 providing an explanation if the answer to any question in this Section 7 is yes. Has the Applicant ever filed bankruptcy? No Yes Does Applicant have any past due tax obligations (including payroll taxes)? No Yes Does Applicant have a judgment against it or currently involved with pending or threatened litigation or regulatory proceeding? No Yes Is Applicant in default under the terms of any loan agreement? No Yes Has any director or 20% owner ever been convicted of a criminal offense other than a minor motor vehicle violation? No Yes 8. Name, address, phone and email for lawyer representing Applicant: 9. Name, address, phone and email for Applicant s accountant: 10. Material Information: Please provide any material details regarding the Applicant (e.g., new large customer/contract, etc.). 7
DIRECT LOAN SUBMISSION CHECKLIST The following documents should be submitted in connection with application under the direct lending program: General Completed Section A, B and F of this application. Check for application fee of $250 payable to the Business Consortium Fund, Inc. (application fee is for direct loan program only). Business Financial Information Applicant s financial statements for last 3 years and interim financial statements for most recent fiscal period. Label Ex. B-1. Applicant s federal tax returns for last 3 years. Label Ex B-2. Account receivable aging statement dated within 30 days of application. Label Ex. B-3. Account payable aging statement dated within 30 days of application. Label Ex. B-4. Schedule setting forth all outstanding debt of Applicant including the original date of the loan, loan amount, present balance, interest rate, monthly payment, maturity date and loan collateral. Label Ex. B-5. Schedule listing any other financial assistance other than that listed in Ex. B-5 that the Applicant has applied for or received. Label Ex. B-6.. Projection of Applicant s cash flow with related assumptions for current fiscal year and the next year. Label Ex. B-7. Credit report for Applicant and all persons owning at least of 20% of Applicant dated within 20 days of submission of application from a recognized credit reporting agency. Label Ex. B-8. Other Business Information Proof of NMSDC certification (e.g. copy of certificate) Label Ex. B-9. Resumes or bios of senior management. Label Ex. B-10. Copies of organizational documents (e.g. articles of incorporation). Label Ex. B-10. Applicant s business plan (if available). Label Ex. B-11. 8
List of Applicant s subsidiaries or affiliated companies. Label Ex. B-12. Schedule B-3 (if applicable) Schedule B-6 Schedule B-7 (if applicable) Potential Guarantor Information (to be submitted by all 20% owners of Applicant and any other guarantor) Copy of most recent federal tax return. Label Ex. B-13. Personal financial statement. Label Ex. B-14. Recent bank account statement and brokerage account statement. Label Ex. B-15. Most recent year end financial statements for any corporate guarantor. Label Ex. B-16. 9
SECTION C: FACTORING Please complete the attached 1 page Express Application if you require factoring financing under $100,000. All others should complete the attached 2 page Full Application. FACTORING FINANCING SUBMISSION CHECKLIST The following documents should be submitted in connection with application under the Factoring program: General Completed Section A, C (either Full or Express Application) and F of this application. Proof of NMSDC certification (e.g. copy of certificate) All documents requested in either the Full or Express Application form. 10
FULL APPLICATION Page 1 In order to expedite the approval process, please fill out this application completely. After initial approval is given, additional information may be required prior to funding. COMPANY INFORMATION Business Name: Date Est.: County: Street Address: Phone: City: State: Zip: Cell Phone: E-mail Address: Web Address: Fax: Legal Status: Corporation LLC Partnership Sole Proprietorship Federal Tax ID Number: Description of Business: _ Number of Employees: Federal or State Taxes Past Due? Yes No If Yes, Type/Amount: /$ Tax Lien Filed? Yes No OFFICERS, OWNERS, OR PARTNERS If there are more than two, please list any additional persons in the Notes section of the application. Name & Title: % Owned Driver s License #: Home Street Address: Own Rent City: State: Zip: Home Phone: E-mail Address: Date of Birth: Social Security #: Name & Title: % Owned Driver s License #: Home Street Address: Own Rent City: State: Zip: Home Phone: E-mail Address: Date of Birth: Social Security #: BUSINESS BANKING INFORMATION Name of Bank: Date Opened: City: State: Zip: Phone: Checking Account Number: Any Commercial Loans Outstanding? Yes No Loan Account Number/Amount: /$ Bank Officer: SUPPLIER INFORMATION NAMES OF PRINCIPAL SUPPLIERS PRODUCTS SUPPLIED PHONE NUMBER A. B. C.
FULL APPLICATION Page 2 MISCELLANEOUS INFORMATION Anticipated monthly factoring volume: Current receivables outstanding: Requested first funding date: Amount of funding required: How did you find out about Riviera Finance? Have you factored before? Yes No If yes, with whom? LANDLORD INFORMATION Are you presently leasing your business space? Yes No Period of Present Lease: Name of Landlord and/or Management Company: Street Address: Monthly Rental Amount: City: State: Zip: Phone: SUPPORT INFORMATION CHECKLIST Please include the appropriate information with your completed application and submit to Riviera. Invoices to Factor (include purchase orders and/or contracts) Customer List with Addresses Accounts Receivable Aging Current Financial Statements Accounts Payable Aging Bank Authorization Form (to be provided) Tax Authorization Form (to be provided Tax Returns Liability Insurance Certificate Articles of Incorporation or Assumed Name Certificate Copy of 941s (last four quarters) with Proof of Payment Cargo Insurance (Trucking Firms) Copy of Operating Authority with MC# (Trucking Firms) Workers Comp. Insurance (Staffing Firms) Copy of Current PACA License (Agricultural Firms) Copy of Applicant(s) Drivers License(s) Notes: SIGNATURE & AUTHORIZATION I understand that the submission of this application to Riviera Finance (hereinafter Riviera) indicates my intention to enter into a Security Agreement with Riviera but does not obligate Riviera to factor/finance or provide any financial services whatsoever. I further acknowledge that the approval to factor/finance or provide financial services may come only after the manager of Riviera approves said application and invoices/accounts offered, in accordance with the terms of Riviera s Security Agreement. The above statements are true and correct to the best of my information and belief. This serves as my permission for the release of any information to Riviera regarding this application for the purpose of credit investigation. I hereby authorize Riviera to investigate the credit of all parties listed above. I also hereby authorize Riviera to contact our customers to verify the invoices submitted for factoring. Signed: Date: Name and Title: Signed: Date: Name and Title: 12
E X P R E S S A P P L I C A T I O N GENERAL BUSINESS INFORMATION In order to expedite the approval process, please fill out this application completely. After initial approval is given, additional information may be required prior to funding. Business Name: Date Est.: County: Street Address: Phone: City: State: Zip: Cell Phone: E-mail Address: Web Address: Fax: Legal Status: Corporation LLC Partnership Sole Proprietorship Federal Tax ID Number: Type and description of Business: Number of Employees: Federal or State Taxes Past Due? Yes No If yes, type/amount: /$ Tax Lien Filed? Yes No OFFICERS, OWNERS OR PARTNERS If there are more than two owners, please list any additional persons on a separate sheet of paper. Name & Title: Percent Owned: Driver s License #: Home Street Address: City: State: Zip: Home Phone Date of Birth: BUSINESS BANKING INFORMATION Name of Bank: Name & Title: Percent Owned: Driver s License #: Home Street Address: City: State: Zip: Home Phone: Date of Birth: FACTORING ACCOUNT INFORMATION Anticipated monthly factoring volume: S City: State: Zip: Current account balance outstanding: S Phone: Date Opened: Have you factored before? Yes No Checking Account Number: If yes, with whom? Any Commercial Loans Outstanding? Yes No How did you find out about Riviera? Amount: $ Collateral Pledged: Additional Notes: Loan Account Number: Bank Officer: SUPPORT INFORMATION CHECKLIST Please include the appropriate support information with your complete application and submit to Riviera. Articles of Incorporation or Assumed Name Certificate Customer List with Addresses Accounts Receivable Aging and Invoices to Factor Bank Authorization Form (to be provided) Tax Authorization Form (to be provided) Liability Insurance Certificate Worker s Compensation Insurance (if requested) Cargo Insurance (Trucking Firms) Copy of Operating Authority (MC# ) (Trucking Firms) Copy of Applicant(s) Drivers License(s) SIGNATURE & AUTHORIZATION I understand that the submission of this application to Riviera Finance (hereinafter Riviera) indicates my intention to enter into a Security Agreement with Riviera but does not obligate Riviera to factor/finance or provide any financial services whatsoever. I further acknowledge that the approval to factor/finance or provide financial services may come only after the manager of Riviera approves said application and invoices/accounts offered, in accordance with the terms of Riviera s Security Agreement. The above statements are true and correct to the best of my information and belief. This serves as my permission for the release of any information to Riviera regarding this application for the purpose of credit investigation. I hereby authorize Riviera to investigate the credit of all parties listed above. I also hereby authorize Riviera to contact our customers to verify the invoices submitted for factoring. Signed: Date: Name and Title: Signed: Date: Name and Title:
SECTION D: ACCOUNTS RECEIVABLE FINANCING Complete this Section and submit requested documents only if applying for a accounts receivable financing. Bank Relationship: Provide the name, address, phone, and contact person at your current bank. Provide details if the Bank or any other party has a security interest in the Applicant s accounts receivable or inventory. Sales Information: Average monthly sales last 12 months: Average monthly sales projected: Average invoice size: $ $ $ Additional Eligibility Requirements: Applicant must finance a minimum of $100,000 of receivables per month and may be in any industry except construction to utilize the Accounts Receivable Financing program. This program is particularly suited to government contracts. ACCOUNTS RECEIVABLE FINANCING SUBMISSION CHECKLIST The following documents should be submitted in connection with application under the Accounts Receivable Financing program: General Completed Section A, D and F of this application. Provide the following documents: Applicant s most recent account receivable aging report. Label Ex. D-1. Applicant s most recent account payable aging report. Label Ex. D-2. Applicant s backlog report (if available) Label Ex. D-3. Proof of NMSDC certification (e.g. copy of certificate) Label Ex. D-4.
SECTION E: LOAN GUARANTY/PARTICIPATION PROGRAM ( LGPP ) Complete this Section E and submit requested documents only if applying for financial assistance under the LGPP. 1. Amount of financing requested: $ 2. Use of Proceeds Working Capital $ Equipment $ Inventory $ Business Acquisition $ Furniture/Fixtures $ New Product Devel. $ Debt Refinancing $ Other $ Please submit a separate schedule marked as Schedule E-2 providing a detailed listing of the equipment, furniture, fixtures and leasehold improvements and/or a description of the business acquisition, debt refinancing, new product development or the other use of proceeds. 3. Provide the names of all the Applicant s directors and officers (indicating all positions held by such person). 4. Provide the names of all owners of twenty percent (20%) or more of the Applicant s stock (indicating the class, percentage of stock owned and voting power of each person). 15
5. Submit a separate schedule labeled Schedule E-5 ) providing an explanation if the answer to any question is yes. Has the Applicant ever filed bankruptcy? No Yes Does Applicant have any past due tax obligations (including payroll taxes)? No Yes Does Applicant have a judgment against it or currently involved with pending or threatened litigation or regulatory proceeding? No Yes Is Applicant in default under the terms of any loan agreement? No Yes Has any director or 20% owner ever been convicted of a criminal offense other than a minor motor vehicle violation? No Yes 6. Name, address, phone and email for lawyer representing Applicant: 7. Name, address, phone and email for Applicant s accountant: 8. Material Information: Please provide any material details regarding the Applicant (e.g., new large customer/contract, etc.). 9. Banking Relationship: Provide the name, address, phone, and contact person at your current bank. 16
LGPP SUBMISSION CHECKLIST The following documents should be submitted in connection with application under the LGPP: General Completed Section A, E and F of this application. Business Financial Information Applicant s financial statements (income statement and balance sheet) for last 3 years and interim financial statements for most recent period. Label Ex. E-1. List all outstanding debt of Applicant including the original date of the loan, loan amount, present balance, interest rate, monthly payment, maturity date and loan collateral. Label Ex. E-2. List any other financial assistance other than that listed in Ex. E-2 that the Applicant has applied for or received. Label Ex. E-3. Applicant s projected cash flow with related assumptions for current fiscal year and the next year. Label Ex. E-4. Other Business Information Proof of NMSDC certification (e.g. copy of certificate). Label Ex. E-5 Resumes or bios of senior management. Label Ex. E-6. Applicant s business plan (if available). Label Ex. E-7. Schedule E-2 (if applicable) Schedule E-5 (if applicable) 17
SECTION F. CERTIFICATIONS The undersigned hereby certifies and agrees that: I am duly authorized by the Applicant to complete and submit this application (including this certification), together with the attached exhibits, attachments and addendums (collectively the Application ), to the Business Consortium Fund ( BCF ); All information in this Application is true and complete, is not misleading and does not contain any material misstatements or omissions; The BCF is authorized to contact banks and other lending institutions in connection with financing under the BCF programs and I also authorize BCF to release this Application and the information contained herein to and otherwise exchange information regarding the Applicant s request for financing with banks and other lending institutions as well as any other entity the BCF deems necessary for any reason related to the requested financing; The BCF is authorized to obtain reports from business and credit reporting agencies on the Applicant in connection with the review of this Application; For financings under the Loan Guaranty/Participation Program, the Factoring Financing Program and the Accounts Receivable Financing Program, that the BCF does not extend any credit or financing directly to the Applicant and therefore the Applicant releases and agrees to hold harmless the BCF from any claims that may arise in connection with such financing; The BCF may publish tombstone notices (e.g., containing information such as the Applicant s name, loan amount, date of closing and level of BCF participation) in its materials, reports and website. The Applicant will notify BCF immediately in writing of any material adverse change (1) in any of the information contained in this Application, (2) in the Applicant s financial condition, and (3) the Applicant s NMSDC certification status. APPLICANT ATTEST By: Name: Title: Date: By: Name: Title: Date: 18