EXHIBIT A – APPLICATION FORM

VERSION: 1 NUMBER OF PAGES: 3

CREATION DATE: 10.01.2020

PREPARED BY: ANGELA PAREDES APPROVED BY: AURELIO ALMONTE

Business Information:

Legal name of Business: Federal Tax ID:

Trade Names (DBA): DUNS number

Address: (No PO Box): City: State: Zip Code:

Name of person to contact: Phone: Fax: Mobile:

Email Address: Web Site: Years in business: # Employees:

Legal form of business: State of Organization:

Corporation Partnership LLC Sole Proprietorship Other_________________
Type of business (Products/Services provide):

Annual Sales (USD $): Estimated Loan amount requested: Type of financing needed: Terms offered: (days)
Term Revolver 30 60 90 other:____
Has the company changed the address, name, or form of organization in the last 2 years? Yes No
If yes, explain:
Does the applicant have any subsidiaries, licensees, or affiliates? Yes No Has the applicant ever filed for bankruptcy? Yes No
If yes, provides the names: If yes, explain:
Does the applicant have any judgments or liens filed against it? Yes No Are there any UCC filings against it? Yes No
If yes, explain: If yes, with whom:
Does the applicant have any pending lawsuits against it? Yes No Does the applicant have any federal or state taxes past due?
If yes, Yes No Explain:
explain:
Have you lost any major accounts in the past two years?
If yes, explain:
Owners/Managers/Principals of Application
Name: % Ownership: Phone:
Title: Social Security: Date of Birth:
Home Address:
Name: % Ownership: Phone:
Title: Social Security: Date of Birth:
Home Address:
Name: % Ownership: Phone:
Title: Social Security: Date of Birth:
Home Address:
Have the owners/shareholders/principals/Manager ever
1) Owned or been part owner in another company Yes No Explain:
2) Been convicted of a felony Yes No Explain:
3) Had any judgments or liens against them Yes No Explain:
4) Had pending lawsuits against them Yes No Explain:
5) Filed for bankruptcy Yes No Explain:
6) Filed a UCC against them Yes No Explain:

Business Credit Information:

Do you have any outstanding loans ? Yes No Loan ___________ Type of Credit: ________
Amount:
Name of lender: Outstanding Terms:
Collateral (if any): Contact Person:
Has the applicant ever defaulted in any financial obligation? Yes No Phone:
If there are any additional loans, please provide details in a separate sheet of paper.
Accounts receivables information:
Outstanding Current 0-30 days 30-60 days 60-90 days 90-120 days Greater than 120 days

Is the applicant currently or has it previously factored its receivables? Yes No What will the funds be used for?
With whom:
Any Consignment, Right of Return, or Similar Allowances? What is the applicant’s common method of getting paid?
Yes No ACH Wire-transfer Check Other:__________________
If applicable, does the applicant have contracts that include clauses allowing passing through increases in Cost of Goods Sold (COGS)? (i.e. raw materials, fuel,
insurance, etc): Yes No
Business References:
Name of contact: e-mail: Phone:
Company name: Length of relationship (months, years):
Business relationship: Supplier Customer Other:_________________________________________________________________
Name of contact: e-mail: Phone:
Company name: Length of relationship (months, years):
Business relationship: Supplier Customer Other:_________________________________________________________________
Name of contact: e-mail: Phone:
Company name: Length of relationship (months, years):
Business relationship: Supplier Customer Other:_________________________________________________________________
Other information
Applicant’s Bank information: e-mail: Phone:
Address City/State/Zip code:
:
Applicant’s Accountant name: e-mail: Phone:
Address City/State/Zip code:
:
For Federal Government Contractors
Cage Registration valid Trading Partner Identification Number
Number: though: (TPIN)

I understand that the submission of an application to Exim Trade Capital does not mean that Exim Trade Capital will provide any financial services whatsoever.
I further understand that approval will come only after the Loan Agreement and all supporting forms have been signed and approved by Exim Trade Capital.
I certify the accuracy of the information provided and understand that Exim Trade Capital will be relying on the accuracy of this information when evaluating
the company’s application. By submitting this application either by mail, fax, or electronically, the company authorizes Exim Trade Capital to use any credit
bureau or business to verify the validity and accuracy of all information contained herein. I consent to Exim Trade Capital’s filing of one or more Initial
Financing Statements against me or the undersigned company in any or all Uniform Commercial Code jurisdictions, which reflect the collateral as “all assets.”
All the information provided is confidential and for the sole purpose of evaluating this application.
Signature Name Title Date

In order to process your application, please enclose the following documents: 1. Signed Application
1. Detailed Current Accounts Receivable Aging Report aged by Invoice Date 2. Signed company certificate and resolution
2. Detailed Current Accounts Payable Aging Report aged by Invoice Date 3. Completed Client list form
3. End of the year A/R and A/P Aging Reports (last 2 years)
4. The most recent Financial Statements (both Income Statements and Balance Additional information:
Sheets) with comparable periods (i.e. March 2018 – March 2019) For Corporations:
5. Last three (3) year’s Financial Statements 1. Copy of any Shareholders Agreement
6. Last three (3) years of Income Tax Returns 2. Copy of any By-Laws
7. Sample of common transaction documents (i.e. Purchase Orders, Invoices, For Limited Liability Companies:
Proof of Delivery to Customer, Contracts, etc.) 1. Copy of an written Operating Agreement
8. Driver’s Licenses of all Owners/Managers/Principals
9. Copy of DBA Filing(s) if applicable
10. Copy of Articles of Incorporation or Articles of Organization if LLC
11. Organizational Chart
Account List: Please provide your current customer list with the revenue contribution (%).

Client name list Information required to factor accounts.

Company Name Street Address/ City / State Zip Phone Contact Revenue Pmt Length of
Code number Name Contributio Terms relationship
n