E-FVG - Debt/Equity Capital Request Form

General E-mail: info@e-fvg.com

Global Fax: 1-484-952-9982

Company Name:

Business Industry:

Country of Registration:

Month & Year Started:

Funding Amt. Required:

Funding Type Sought:

Intended Use of Funds:

Amt. Invested by Owners:

Add. Amounts Raised:

Contact Person (Full Name):

Position/Title (eg. "CEO):

Contact Phone:

Contact Fax:

Contact E-mail:

Short Venture Description:

(500 words max.)

Business Documentation:

Desired Syndication Package:

Preferred Payment Method:

(This is NOT a purchase)

Month YYYY

Business Intelligence Summits

Venture Capital Placement

Developing Global Businesses

E-Fortune Venture Group

1-800-610-E-FVG

USA/International Strategic Business Intelligence and Venture Capital for Emerging Growth Companies

Debt/Equity Capital Request Form

Please complete ALL fields and click the "SUBMIT" button

NB. Syndication desk levels all include investment rating analysis and video pitch production. Please Click Here to see the full syndication package details. This payment goes to the investment rating company which

owns and operates the syndication platform used by E-FVG. Pricing here does not include E-FVG's Consultancy Retainer Fee.

USD

THIS IS NOT AN OFFER TO SELL SECURITIES NOR A SOLICITATION OF AN OFFER TO BUY ANY SECURITIES IN THE UNITED STATES OR ANY OTHER JURISDICTION WHERE THEIR OFFER OR SALE IS NOT PERMITTED. ONLY "ACCREDITED INVESTORS" (AS DEFINED IN REGULATION D UNDER THE U.S. SECURITIES LAWS) WHO HAVE FURTHER QUALIFIED AS MEMBERS OF THE SUBJECT INVESTOR NETWORK MAY VIEW SPECIFIC INFORMATION AND MAY PARTICIPATE IN THE SUBJECT PRIVATE EQUITY MARKET.

This service is for Financially Solvent Companies only, not entrepreneurs still at the "Idea" stage.

If your company has less than $25,000 in liquid assets, we strongly suggest you approach "friends and family" first to raise basic seed capital, before applying for major venture capital here.

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BARBADOS . LONDON . LOS ANGELES . MIAMI NEW YORK . ONTARIO . TORONTO .