Please complete all fields marked * before submitting this form to 73 Energy. Fields without an asterisk should be completed where information is available. All information provided will be treated as strictly confidential. Do not share this form with any third party.
| Full Name* | |
| Company / Organisation* | |
| Email Address* | |
| Phone / WhatsApp* | |
| Your Role in This Transaction* |
| Full Legal Company Name* |
|
| Country of Incorporation* | |
| Registered Business Address* | |
| Contact Person — Name & Title* | |
| Contact Email* | |
| Contact Phone* | |
| Bank Name* | |
| Bank Branch & Country* | |
| Bank SWIFT / BIC Code* | |
| Bank Account Number / IBAN* | |
| Years in Operation(optional) | |
| Estimated Annual Trading Volume(optional) | |
| Preferred Payment Terms* e.g. LC at sight, CAD, Open Account, Prepayment |
| Full Legal Company Name* |
|
| Country of Incorporation* | |
| Registered Business Address* | |
| Contact Person — Name & Title* | |
| Contact Email* | |
| Contact Phone* | |
| Bank Name* | |
| Bank Branch & Country* | |
| Bank SWIFT / BIC Code* | |
| Bank Account Number / IBAN* | |
| End Use of Commodity* Confirm specific purpose — e.g. confectionery manufacturing, animal feed, resale | |
| Buyer's Preferred Payment Terms* | |
| Is Buyer willing to open an LC?* If yes, confirm whether Transferable or Confirmed LC is acceptable |
| Commodity Name* | |
| HS Tariff Code* | |
| Grade / Quality Specification* | |
| Moisture Content Maximum(optional) | |
| Other Quality Parameters(optional) | |
| Quantity (Metric Tons)* | |
| Quantity Tolerance (+/-)(optional) | |
| Packaging* e.g. Bulk, Bagged (specify kg per bag), ISO Tank, Flexi-bag | |
| Applicable Contract Standard* e.g. GAFTA, FOSFA, ISO 8217, or other applicable standard | |
| Certificate of Origin Required?* | |
| Phytosanitary Certificate Required?* | |
| Certificate of Quality Required?* | |
| Inspection Company (preferred)(optional) | |
| Other Required Documents(optional) |
| Buy Price (from Seller) per MT* | |
| Sell Price (to Buyer) per MT* | |
| Total Buy Contract Value (USD)* | |
| Total Sell Contract Value (USD)* | |
| Pricing Basis* Fixed price or floating — if floating, state index and differential | |
| Price Reference Date / Period(optional) | |
| Transaction Currency* | |
| Incoterms (with year)* e.g. CIF Rotterdam 2020, FOB Santos 2020 | |
| Additional Pricing Notes(optional) |
| Load Port — Name & Country* | |
| Discharge Port — Name & Country* | |
| Earliest Shipment Date* | |
| Latest Shipment Date* | |
| Estimated Transit Time (days)(optional) | |
| Vessel Arrangement* Seller's vessel / Buyer's vessel / To be nominated / Freight included in price | |
| Freight Cost (if applicable)(optional) | |
| Transit Route(optional) | |
| Demurrage Rate (USD/day)(optional) | |
| Laytime Terms(optional) e.g. 72 hours SHINC, SHEX EIU | |
| Port Agent at Load Port(optional) | |
| Port Agent at Discharge Port(optional) |
Please provide any financing information relevant to this transaction. Do not share confidential details of your own company's financing arrangements — only information directly relevant to structuring this specific deal.
| Do you have an existing financing arrangement for this deal?* | |
| Estimated financing requirement (USD)* | |
| Preferred financing duration (days)* | |
| Does the buyer have an existing banking relationship that can support LC issuance?* | |
| If yes — name of buyer's LC issuing bank | |
| Is a Transferable LC acceptable to the buyer?* | |
| Is a Confirmed LC acceptable to the buyer?* | |
| Does the seller require advance payment or upfront deposit?* | |
| Are there any known restrictions on USD or EUR payment flows in this corridor?* | |
| Have you previously traded this corridor with financing support? |
Please confirm each of the following by selecting YES or NO. Where the answer is NO or UNKNOWN please provide details in the notes field.
| Compliance Question | YES / NO | Notes (if applicable) |
|---|---|---|
| To the best of your knowledge, is the Buyer free of any UK, EU, or US sanctions designation? | ||
| To the best of your knowledge, is the Seller free of any UK, EU, or US sanctions designation? | ||
| To the best of your knowledge, is the Buyer's bank free of any UK, EU, or US sanctions designation? | ||
| To the best of your knowledge, is the Seller's bank free of any UK, EU, or US sanctions designation? | ||
| Does the commodity have any military, dual-use, or controlled application? | ||
| Is the end use of the commodity purely for food, industrial, or commercial purposes? | ||
| Do you hold KYC documents (company registration, director ID) for the Buyer? | ||
| Do you hold KYC documents (company registration, director ID) for the Seller? | ||
| Are you aware of any existing legal disputes, liens, or encumbrances on this cargo? | ||
| Do you confirm this transaction is not structured to evade sanctions or regulatory obligations? |
I confirm that the information provided in this form is accurate and complete to the best of my knowledge. I understand that 73 Energy will rely on this information to make commercial and compliance decisions. I accept responsibility for any material inaccuracies in the information I have provided.