AVALON FINANCE, INC.
Financing Solutions for Investors, Business Owners
and Developers of Commercial Projects
(Items in red are REQUIRED)
Personal Information
Your Name
Company Name
Title
Telephone
Alternate Phone
Email
Fax
Mailing Address
Mailing Address 2
City
State
Country
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Security To Be Pledged
Ticker Symbol
Exchange
Number of Shares
Total Value U.S. $
Your relationship to the stock (ie: owner, agent, other)
Stock Owner (if different from applicant)
Status Of Shares (restricted, margined, free trading, lock up agreement in place, etc.)
Desired Transaction (Loan or Block Sale)
Additional Comments
