e-Authorization

Bill To:

Name(Required)

First Last

Legal Entity/Company Name(Required)

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone (XXX) XXX-XXXX(Required)

What are your short-term 30-day funding goals?(Required)

Based on our WHAT WE DO page (Option #10), please define the help you are authorizing us to provide.(Required)

All diverse, long-term client needs listed (other) than #10 on the WHAT WE DO page are to be disclosed on the INTAKE FORM found on the CONTACT US page. Long term needs are also subject to individual client contract (on their company letterhead) and approval from annual payroll funder. WHAT WE DO page, option #10 - has a 4 funding referral limit subject to verification of client eligibility. This includes proof of monetizable assets // revenues // hard assets // or IP. Client meeting funding approval sliding-scale success-fee rate is 10-5-1% of transactional amount (previously disclosed on our blog feed SinCityFinancier.wordpress.com). Transactional scale is; $500K (minimum) = 10% // $10M+ = 5% // $100M+ = 1% (per round not accumulative total).

Agreement Terms

By signing below, you agree to Authorize Global Crossroads Capital to perform the Option #10 services defined above on your behalf. Client agrees to the above scale rates defined by clients transactional amount success (per round); to be paid at close (and all collection/legal/interest costs IF applicable for non-compliance).

Signature(Required)