Funding Company / Strategic Partner Application
Business Legal Name:
State of Incorporation:
Business D.B.A
FED ID#
Business Address:
City/State/Zip:
Business Phone#
Alt Phone#
Fax Phone#
Ownership / Officers (Attach Additional Sheet if More than 2):
Principal #1:
Date of Birth:
SS#:
-
-
Home Address:
City/State/Zip:
Email:
Cell Phone #
Home Phone #
Citizen of what country? & State:
Percentage Ownership of Business
Drivers License# & State:
Have You Ever Been Convicted of a Crime?
IF YES PROVIDE DETAILS:
Principal #2:
Date of Birth:
SS#:
-
-
Home Address:
City/State/Zip:
Email:
Cell Phone #
Home Phone #
Citizen of what country? & State:
Percentage Ownership of Business
Drivers License# & State:
Have You Ever Been Convicted of a Crime?
IF YES PROVIDE DETAILS:
Are there any pending or threatened legal proceedings against you or your company?
Are you comtemplating a bankruptcy filing, recorgnization or sale of your business?

I hereby represent that all of the above information is true and that I understand that making false statements might be considered fraud. By providing the above information, I/we, the applications(s), authorize World Global Financing inc. (WGF) it's Agents or Assigns to investigate my/our background, financial condition and credit worthiness and that of the business above and will provide financial statements, tax returns, upon your request. I/we authorize World Global Financing inc. (WGF) to update my/our credit profile(s) from time to time in ther future as you deem appropriate.

Principal#1 Signature:
Date:
Principal#2 Signature:
Date: