Capital International Fund Assistance | International Business Loans | Convergex



Intermediary Opportunity Form

About this form
A fully-completed copy of this form must accompany some form of complete, written documentation (in English) for your client's project. In order for Convergex Caribbean, Ltd. to protect any written fee arrangement you may have with your client, such must also be included with the documentation after submitting this form.

The information you provide us through this form will not be given or sold to any third party outside the funding process under any circumstances. Read our confidentiality statement at the bottom of this page for more information regarding how we use your data.

 Requirements
  • Complete all fields.
  • Enter valid e-mail address

Project's Legal Name
 Type of Finance   
Other:    
Business/Project URL
(IE: http://www.businessproject.com)
 Precise Amount of Capital (USD$)
$
(Format: "x,xxx,xxx.xx") (Minimum: 1,000,000)
Use of Proceeds:
 Business Sector:


(select from menu or type in above)



Principal's Full Name
  		 Address
(Street Address)
(Suite, PO BOX, etc)
Business Name
 City
Telephone
-  
State/Province


(select from menu or type in above)		 Postal Code
Fax
-  		 Country
Email (yourname@email.com)
  



Broker's Full Name
  		 Address
(Street Address)
(Suite, PO BOX, etc)
Business Name
 City
Telephone
-  
State/Province


(select from menu or type in above)		 Postal Code
Fax
-  		 Country
Email (yourname@email.com)
  



How did you acquire this client?
 When did you acquire this client?
How long has the client been in business?
 How is the client organized?
How long have you known the principals?
 How long has this client been seeking funding?
Has this client ever declined any funding offers? If yes, please explain below:
 Are your clients aware of and prepared to pay loan costs?
YES     NO



How did you learn about our company?
 If other, where?



I UNDERSTAND THAT THE WORLD OF PRIVATE, COMMERCIAL INTERNATIONAL FINANCE IS EXTREMELY FAST-PACED. I, THEREFORE, AGREE TO CONTACT CONVERGEX BY TELEPHONE WITHIN 24 HOURS OF RECEIPT OF MY DOCUMENTATION BY CONVERGEX. FURTHER, I UNDERSTAND THAT FAILURE TO MEET THIS CONSTRAINT OF TIME MAY DISQUALIFY MY CLIENT'S PROJECT FOR NOMINATION TO FUNDING SOURCES.

If accepted by this office, your Client's project will be nominated to a Funding Source. At this point, Convergex MAY extend an invitation to your Client to meet with us for the purpose of arranging Funder introductions. CONVERGEX will make every effort on your behalf to cause this to happen, but cannot guarantee that your Client - or their project - will qualify for invitation to such a meeting.

This form is intellectual property of Convergex. ALL content and submission data is Confidential and Proprietary.
 Initials:


NOTE: By submitting this form you are agreeing to our Terms of Site Use.

                
CONFIDENTIALITY STATEMENT: CONVERGEX fully appreciates the need to handle your business planning documentation with the utmost care and consideration of the private and confidential nature of its contents. One of the values most often expressed as essential by our Clients, of the services we provide, is the absolute discretion associated with our relationship. As an International (Bahamas-based) company, CONVERGEX is strictly bound to the same level of absolute secrecy as money managers and their clients have learned to appreciate in Swiss banks, as well as those in the Channel Islands, the Cayman Islands and elsewhere in the world.

As such, your documentation - and every detail of your financial affairs - will be shared on a strictly need-to-know basis. Be assured, that a hallmark of the unique and valuable services we provide includes our appreciation for the highest degree of privacy and confidentiality associated with commercial international finance.