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FACTORING SHORT FORM
QUESTIONS?
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We offer one of the lowest factoring fees in the industry. For a price quote, please complete the Short-Form below.

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GENERAL INFORMATION
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Legal Name of Business
City
State
Contact Name
Your Position With The Company
Email
Phone
Fax
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COMPANY INFORMATION

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Type of Business
If Other, Explain
Type of Products/Services Offered
Name of CEO
How Long In Business
Number of Employees
Type of Ownership
State of Incorporation (if applicable)
Is Your Company Public or Private?
Public Private
. .

ABOUT ACCOUNTS RECEIVABLES
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Dollar Amount of Receivables Now Open
Average Monthly Sales
Total Sales Last 12 Months
Total Returns last 12 months (if none put "none")
Percentage of Bad Debts last 12 Months
Approximate Number of Customers
Do You Sell on Terms of Net: 10 days 30 days 60 days 90 days
Do You Offer Early Payment Discounts: NoYes (If yes, what percentage?%
Average Invoice Amount
Are Your Accounts Receivables Pledged as Collateral? No Yes If YES, to whom?
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ANTICIPATED MONTHLY FACTORING VOLUME
Amount You Intend To Factor on Monthly Basis  
Maximum Anticipated Annual Factoring Volume

Are You Factoring Now or Factored in the past?

Yes No

If Factoring Now

If Factored in the Past

.

HOW DID YOU HEAR ABOUT US?   ------------------------>

Thank you for submitting the online form and for the opportunity to provide you with excellent factoring services. The person that handles your local area will contact you shortly.