Renewable Global Energy's Online Application-PartA

Full Name of Person filling out this form *
Your Position *
Company Name *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone Number *
Fax Number *
Email Address *
Website *
Are You a Broker? *
Do you have a Mandate? *


Type of Organization (C Corp, LLC, etc) *
Date and State of Incorporation *
Years in Business *
Number of Shares *
Full Names of Primary Principal(s) and LLC or Corp NameProject Name *
All Contact Phone Number(s) office - cell - home etc. *
Types of Products/Services *
Patents/Trademarks *
Industry *
Market *
Competitive Advantage *
Gross Sales Last 3 Years *
2012 EBITDA *
Audited Financials *
Have attempted to raise money (status/name of intermediary) *
Method used to raise capital *
Cash Reserves *
Executive Summary (2-5 pages) *
Summary of Last Three Yrs Financial *
Three Year Pro Forma *
Current Balance Sheet and P&L *


Project Name *
Description of Project (including Location) and Use of Funds *
Developer Experience - Describe Briefly *
Amount of funding requested (US Dollars) *
Amount Of Cash Injection So Far (US Dollars) *
Total Project Value / Cost (US Dollars) *

Do you have Off-Take or Power Purchase Agreements negotiated?

Yes or No *
If Yes - Describe
Is the land secured for this project yet? Explain *
Do you have a Business Plan, Proforma or Executive Summary prepared? *
Other Comments - Please provide any other information that may help us help you get your project funded.
IE: State of readiness - zoning completed? permits obtained? "Shovel Ready"?
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*Please Note: Renewable Global Energy nor MBE Services Inc. does not guarantee the online application made through this website will be approved for funding. All applications are screened and only those who qualify may be approved. By applying for funding of your project through this website, you understand and agree that Renewable Global Energy and/or MBE Services Inc reserves the right to assign the funding to a third-party reputable Company and also has the right to share the information that you provide in the Application to such Third-Parties.