Client Profile And Consent

(Confidential Information, this Information will only be used by/RC Funding Resources, and Eiland Enterprises, And Relating Sources for Acceptance (for internal use.) Each space has to be filled out,  if it does not apply then enter NONE.

Legal Company Name:

Date Company Established:

Company Address:

City:

State:

Country/Province:

Zip Code:

Phone:

Fax:

State Of Incorporation:

Date Of Incorporation:

Fed.Tax I.D. No.(SSAN):

Business Description:

Existing Taxes ? (If  "Yes", please explain.)

Existing Liens and Or Judgements? (If "Yes", please explain.)

Receivables Pledged? (If "Yes", please explain.)

           Principals Of Company_________

President:

Soc.Sec.#

Vice.Pres.:

Soc.Sec.#

Secretary:

Soc.Sec.#

Soc.Sec.#

Treasurer:

Trade References:

By Filling This Form, You are authorizing RC Funding Resources To review information that you have provided(True), and allow us to exchange information about you, to our Associating Sources for Acceptance. RC Funding Resources advises Prospective Client  to seek and or consult with their Attorney and Financial Advisor. Client will not hold RC Funding Resources, Nor Associating Sources, Responsible for any actions or decisions made by Client, or  any parties acting in their behalf.