Information Form for Buyer Credit

Select Location

Exporter's Legal Company Name:

Address (in full)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Name of Contact

First Name Last Name

Title

Phone Number

Fax

E-mail

Website

Latest Total Sales Amount:

Year Ending

Buyer's Legal Company Name

Address (in full)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Requested Financing

Has a Contract Been Signed?

Yes No

At What Stage is Your Proposal?

Preliminary Discussions Bidding Stage Advanced Discussions Draft Contract

Please Attach Copy of Contract

Contract Value

Currency

Have Payments Been Made to the Buyer? (No/Yes, Please Explain)

What Products, Goods or Services Will Be Exported?

Nature of the Equipment Exported (i.e. standard, highly customized, tailor-made, etc.)

Installation Required?

Yes No

Type of Installation (i.e. services to be performed, testing, etc.)

Estimated Time to Complete

Please ensure value of equipment + value of installation is equal to 100%

	%
Value of Equipment
Value of Installation

Does the Equipment Contain Major Components from Exporters of Other Countries?

Yes No

	Component	Value ($)	Exporter Name	Address
1
2
3
4
5

Please complete the attached Canadian Content Declaration form (unless your company has Canadian Content Certification from EDC)

Canadian Content

Please Confirm the Component of:

U.K. Content

EU Content

Proposed Delivery Terms

Free on Board/Free Carrier Multimodel (FOB/FCA) Cost, Insurances and Freight/Carriage and Insurance paid (CIF/CIP)

Proposed Payment Terms? (Dollar value or %)

	Dollar Value	%	Estimated Date
Buyer's Downpayment
Other Payments (1)
2
3
4
5

Invoices Require Buyer Approval

Yes No

Previous Dealings with Buyer

Yes No

For How Long?

Rating of Experience with Buyer?

Good Fair Poor

Pending Lawsuits Against Firm

Yes No

Product/Service Require Export Permit?

Yes No

Environmental Issues Associated with the Content, and/or Operation of the Product/Service? (If so, please describe)

Are all the goods purchased (shipped or ready for shipment) and/or all services rendered?

Yes No

Are the terms of payment "a down payment (of 15% or greater) and balance upon shipment"?

Yes No

Contract Value >20% Firm's Average Sales Over Past Two Years?

Yes No

Please provide the following information:

Latest three years financial statements (including balance sheet, income statement, statement of charges in financial position, notes).
Bank line of credit information (including contact name and telephone number, current bank Term Sheet outlining limit and security, and a statement from the bank confirming current utilization).
Cash flow projections (for the proposed transaction and for your company).

Institution

Account Manager

First Name Last Name

Phone Number

Please certify that the above infomraiton is true and correct as of the date of this Application

The Applicant authorizes Interlink Capital Strategies to obtain any information required from the Applicant's bank or from a credit agency.

Authorized Signature

Clear

Date

Month Day Year

Name

First Name Last Name

Title