Business Development Evaluation Form
Please complete the form below so that First Electronic Bank can properly respond to your partnership request. If you are not certain on the answer to a specific question, please indicate 'unknown'.
A First Electronic Bank representative will be in touch with you within 48 hours of this form being submitted.
Thank you for your interest in First Electronic Bank.
What is the name of the Business.
Contact First Name
Contact Last Name
Company Industry Type
Medical Services or Healthcare Professionals
Company Financial Profile (EBITDA/ASSET SIZE)
Start-up, or, <5 years, provide Capital Investment Amount, and Current Cash Position.
Company Principals or Capital Investors
Name of Principals or Capital Investors
Network Branded, Open Loop Credit
Network Branded, Re-loadable Prepaid
Closed-Loop, Private Label Prepaid
Network Branded Gift
Network Branded, Closed-Loop Credit
Private Label Credit
Credit Ranges Offered
If this is NOT a credit product enter 'NA'
Prepaid Min / Max Load Amt
The min and max amount load allowed on the card. If not a Prepaid product enter 'NA'.
Interest Rate or Range
If not a Credit Product enter 'NA'.
On Balance Sheet (Debit / Equity)
Off Balance Sheet (SPV)
Current # of Accounts and $$ Volume
3 year Forecast # of accounts and $$ volume
Send me a copy of my responses
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