Let us help you raise funds for your business

Is your business in need of a capital infusion? BLG has a network of investors and financial institutions that can help qualified businesses with their equity or debt financing needs.

BLG will match qualified businesses with the right investor for your financing needs.

The first step is to complete the application form below. Take your time, as your responses may be passed to potential investors. The more thorough your responses, the stronger your application can be.

Once you submit your business plan, proforma, and application below, you will have the option to book an appointment with a BLG specialist to review your application and further discuss your financing needs.

FUNDING REQUEST APPLICATION

Contact Name:

Email:

Telephone:

Company/Project Name:

Type of Capital Raise? (Choose all that apply):

Equity Option

Debt Option

How much Capital are you looking to raise? (in USD):

Is the project/company a start-up or scaling an existing project/company?

If an existing project/company, please attach 3 years of historic financial statements.

Has the project/company raised money to date that can be used as collateral?

If yes, can you provide proof of funds?

Executive Summary of business / project for which you seek funding:

List all sources and uses of funds for project and USD amounts associated with each (total sources must match total uses)

	Sources of funds	$ USD	Uses / Purposes of funds	$ USD
1	1, Sources of funds:	1, $ USD:	1, Uses / Purposes of funds:	1, $ USD:
2	2, Sources of funds:	2, $ USD:	2, Uses / Purposes of funds:	2, $ USD:
3	3, Sources of funds:	3, $ USD:	3, Uses / Purposes of funds:	3, $ USD:
4	4, Sources of funds:	4, $ USD:	4, Uses / Purposes of funds:	4, $ USD:
5	5, Sources of funds:	5, $ USD:	5, Uses / Purposes of funds:	5, $ USD:
6	6, Sources of funds:	6, $ USD:	6, Uses / Purposes of funds:	6, $ USD:

Total Sources:

Total Uses:

Expected timeline and milestones for investor’s return on investment:

SUMMARY of Company or Project’s 5-year projected financials

	Year 1 ($ USD)	Year 2 ($ USD)	Year 3 ($ USD)	Year 4 ($ USD)	Year 5 ($ USD)
Total Revenue	Total Revenue, Year 1 ($ USD):	Total Revenue, Year 2 ($ USD):	Total Revenue, Year 3 ($ USD):	Total Revenue, Year 4 ($ USD):	Total Revenue, Year 5 ($ USD):
Total Operating Expense	Total Operating Expense, Year 1 ($ USD):	Total Operating Expense, Year 2 ($ USD):	Total Operating Expense, Year 3 ($ USD):	Total Operating Expense, Year 4 ($ USD):	Total Operating Expense, Year 5 ($ USD):
EBITDA	EBITDA, Year 1 ($ USD):	EBITDA, Year 2 ($ USD):	EBITDA, Year 3 ($ USD):	EBITDA, Year 4 ($ USD):	EBITDA, Year 5 ($ USD):
Free Cash Flow (FCFE)	Free Cash Flow (FCFE), Year 1 ($ USD):	Free Cash Flow (FCFE), Year 2 ($ USD):	Free Cash Flow (FCFE), Year 3 ($ USD):	Free Cash Flow (FCFE), Year 4 ($ USD):	Free Cash Flow (FCFE), Year 5 ($ USD):

If seeking debt financing, please list assets that may be used to support the loan

	Asset Description	Current Asset Value ($USD)
1	1, Asset Description:	1, Current Asset Value ($USD):
2	2, Asset Description:	2, Current Asset Value ($USD):
3	3, Asset Description:	3, Current Asset Value ($USD):
4	4, Asset Description:	4, Current Asset Value ($USD):
5	5, Asset Description:	5, Current Asset Value ($USD):
6	6, Asset Description:	6, Current Asset Value ($USD):

If you were referred by someone, please tell us the name of the person who referred you

Referrer First Name:

Referrer Last Name:

BLG FUNDING SOLUTIONS

BLG FUNDING SOLUTIONS

Let us help you raise funds for your business

FUNDING REQUEST APPLICATION