Factoring, Business Notes, Receivable Funding, Foreclosures -- Global Concepts Funding

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Funding Application

Consultant Information	Your Consultant Id or Ext No:
First Name:		Last Name:
Telephone Number:		Fax Number:
Email:
Company Information
Title(Contact):		Best Time to Call:
First Name:		Last Name:
Company Name:		Tax ID Number:
Company DBA Name:
Business Type:
Date Registered/Incorporated:		State:(US/CA Only)
Street address:		Street Address ln2:
City:		Post Code:
Country:		State:(US/CA Only)
Telephone Number:		Fax Number:
Email:
Business Operation/Principals
President/CEO/Owner First Name:		Last Name:
	Social Security Number:	% Ownership:	Home Phone:
	Home Address:
VP First Name:		Last Name:
	Social Security Number:	% Ownership:	Home Phone:
Principal/Secratery First name:		Last Name:
	Social Security Number:	% Ownership:	Home Phone:
Number of Employees:		Type of Request:
Banking and Financial Information
Bank Name and Address:
Contact Name:		Telephone Number:
ABA Routing Number:		Account Number:
Are Company Taxes Up To Date?		Payment Plan in Place?
Principal Accounts/Clients
Client Name	City,State,Zip	Telephone	Average Monthly Billing



Describe How We Can Help
Please Describe Your Needs:

The undersigned, at initiation of its realtionship with GCI Funding, a Colorado LLC company, warrants that there are no Local, State or Federal Tax Liens or previous UCC filings against its current or future accounts receivable, and shall pay a desposit of $250.00 which deposit shall be applied to cost of filling UCC-1 financing statement(s) or any other public record required by GCI Funding or its affliates, to comply with applicable state or federal laws.

The undersigned further grants GCI Funding or its affiliates authority to sign its name on UCC-1 Financing Statement(s) in order to effect filings according to the tenor of any and all current and future Purchase and Sales Agreements, and/or any loan documents that may be executed by the parties or for any debtor notification necessary to inform undersigned's account debtors of any and all assignments.

Undersigned further agrees that it will not further encumber the assets set forth in the Purchase & Sales agreement or other Security Agreement or increase the indebtedness thereon, or transfer or assign assets except in the ordinary course of busness.

In addition, the undersigned shall be responsible to reimburse GCI Funding and its associates for expenses actually incurred on behalf of the undersigne including, but not limited to the Federal Express, USPS (and others) chargs, credit investigations, lien searches, and periodic tax lien searches.

GCI Funding and its associates shall be authorized to deduct all such expenses from any moenys it shall be holding to credit of the undersigned.

Global Concepts Funding

Online Application

...Call us at 1-303-351-9360