Note: Before you fill out and submit the information below you must be sure the following conditions are met:

1. Transaction takes place in the U.S.
2. We must be able to Inspect product in U.S. with a bonded inspector
3. We will fund nothing under $20,000. We will fund nothing over $1,000,000
4. If your profit margin is not a minimum of 15% than we won 't fund as our interest rate is 6% a week.
5. You must fax to us a copy of your P/O to your supplier, your buyer 's P/O to you, your supplier 's invoice to you, and your invoice to your buyer. ALL 4 DOCUMENTS MUST HAVE THE IDENTICAL DESCRIPTION OF THE PRODUCT WORD FOR WORD, and the confidentiality agreement that you want TBN to sign

Your Information:

Your Company:
Your Full Name:
Your Email Address:
Your Street Addr 1
Your Street Addr 2
Your City:
Your State:
Your Zip:
Your Country:
Your Day Tel:
Your Eve Tel:
Your Cell Tel:
Your Fax #:

Your Supplier's Information:

Supplier's Company:
Supplier's Contact:
Supplier's Email Address:
Supplier's Street Addr 1
Supplier's Street Addr 2
Supplier's City:
Supplier's State:
Supplier's Zip:
Supplier's Country: (US Only)
Day Tel:
Supplier's Eve Tel:
Supplier's Cell Tel:
Supplier's Fax #:

Your Buyer's Information:

Buyer's Company:
Buyer's Contact:
Buyer's Email Address:
Buyer's Street Addr 1
Buyer's Street Addr 2
Buyer's City:
Buyer's State:
Buyer's Zip:
Buyer's Country: (US Only)
Day Tel:
Buyer's Eve Tel:
Buyer's Cell Tel:
Buyer's Fax #:

Transaction Data:

Product To Be Insured
Product To Be Insured Quantity
Condition of 1st Product:	Select Condition Brand New Retail Box New Brown Box Refurbished Tested/Working As-Is
A minimum of 2 website addresses where TBN can view a description of the product and market selling price
What you are paying for the product ea.
What you are paying for entire transaction:

Please enter any additional information that will help TBN help you in facilitating this transaction:

Click 'Send' Button to send to TBN, you will be contacted shortly by a TBN Representative during normal business hours.

If you have any questions or concerns, please contact TBN at (866) 419-3494.

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