* EXIM BANK U.S. EXPORTER * FOREIGN BUYER *
EXIM INSURANCE/FINANCE/FUNDING REQUEST
Company Name
[Company to receive funds]
Principal Name
[Authorized principal to sign documents for company, receiving funds]
Email
[Authorized principal to sign documents for company, receiving funds]
Phone
[Authorized principal to sign documents for company, receiving funds]
What is the requested TRANSACTION amount?
(enter only numbers; Minimum 5000000 = $5,000,000)
How long have you been in business? (include years in current business)
(enter only numbers; i.e. 5 = 5 years)
Do you own or are beneficiary of the Standby Letter of Credit [SBLC]
Yes
No
If yes, upload copy of the investment grade instrument at the UPLOAD DOC button/area in form
Do you have copy of contract for goods and/or services?
Yes
No
If yes, upload copy of the contract at the UPLOAD DOC button/area in form
Will you be generating invoices against the contract for goods and services?
Yes
No
Do you have outstanding invoices you want to cash against?
Please Select
Select
Yes
No
If yes, upload copy of the invoice[s] to be financed at the UPLOAD DOC button/area in form
Select the type of invoices you generate (select all that apply)
Business Invoices
Construction Invoices
Trucking Invoices
Other
What is your monthly business volume? [i.e. cash, accounts receivables, invoices transactions, COMBINE ALL]
(enter only numbers; i.e. 250000 = $250,000)
For trade/credit insurance, or cost insurance and freight coverage [CIF], insurance?
I would like insurance
Upload copy of the trade/credit insurance form provided at the UPLOAD DOC button/area in form
Select what the funding requested will be used (select all that apply)
Monetization investment grade instrument
Inventory financing
Equipment financing
Exim based finance/lending programs
Accounts receivable financing
Other
Do have have foreign invoices you generate?
Yes
No
COPY link http://wheresmyinsurance.com/#
Commercial Fee Agreement is to be signed for payment of monetization funding services.
Yes, please send
No, DO NOT SEND
Do you agree to sign and return Commercial Fee Agreement?
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Brief summary description of funding request usage
Upload Docs
Browse Files
[ If marked "YES" in areas requiring documents to be provided.]
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NAIC CODE – SEE LINKto search applicable NAIC code to provide: https://www.naics.com/search/
Input the NAIC code
DUN & BRADSTREET Number
https://fedgov.dnb.com/webform/index.jsp
CREATE/TYPE LOG IN USERNAME
1 upper case; 1 lower case; 1 special character [i.e. Gfairleysmith_1]
CREATE/TYPE LOGIN PASSWORD FOR EXIM ACCT SETUP
1 upper case; 1 lower case; 1 special character [i.e. Success1]
Best contact time and method
Email
Phone
Time [9 am - 12 noon]]
Time [1 pm - 5 pm]
Time [5 pm - 9 pm]
Other
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