Debt Equity Drawdown - DOC

Document Sample
Debt Equity Drawdown - DOC Powered By Docstoc
					                         CAPITAL RAISING SUBMISSION FORM
Please note that this form is essential if you are raising capital through Equility Capital. It
assists us in deciding first of all if we can assist, and then exactly how we can go about it. All
these forms are reviewed and we will come back to you within three working days with a
firm answer as to if and how we can assist. Please do not attach full business plan at this
stage. When completed please e-mail to contact@equilitycapital.com.
NAME OF COMPANY:
ADDRESS:
COUNTRY:                                       POST/ZIP CODE:
TEL:                                           FAX:
E-MAIL:                                        WEBSITE:
MAIN CONTACT NAME:                             POSITION:
PRIVATE OR LISTED? (If listed insert exchange and ticker/code):
TYPE OF COMPANY (Property, Energy etc):
IF A SPECIFIC PROJECT, PLEASE ADVISE LOCATION:
TOTAL FUNDING REQUIRED (US$, GB£ or €):
DRAWDOWN REQUIRED (Month/$ amount, ie: Month 1/$20m, Month 4/$50m etc)
BRIEF DESCRIPTION OF PROJECT (500 words max) Please include summary of key
management or name of management company, past three years t/o and profit (if available)
any USP’s and the market you serve:
FINANCIAL SUMMARY
This summary required for companies seeking PIPE (Private Investment in Public Equity)
funding in preparation of IPO or reverse merger activity. Also for companies seeking major
property, construction, energy and similar projects usually over $100m.


Company                                      Website
Business                                     Currency                 Year end
Type

Income Statement (‘000s)

                      2007               2008                2009                 2010
Revenue
EBITDA
Earnings

Most Current Balance Sheet (‘000s)

Working Capital
(current assets - current liabilities)
Funded Debt
Shareholder Equity

Funding (‘000s)

Amount Requested
Type (equity/debt)
Company Enterprise Value
(debt + equity, pre-money)


Reserves (if applicable, ‘000s)

Commodity Type
Proven
Probable

				
DOCUMENT INFO
Description: Debt Equity Drawdown document sample