| Title
With Company : |
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Company
: |
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| First
Name : |
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Industry
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| Last
Name : |
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City
and State
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| Telephone
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Mobile
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| Email
: |
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Fax
: |
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| TELL
US ABOUT YOUR EXISTING FACTORING
ARRANGEMENT: |
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| Current
(average)
Monthly Factoring |
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| How
Long Have You Been Factoring? |
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| Do
you expect to Factor For at least
Next 24 Months? |
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| Interest
Rate on Funds Employed |
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| Comments
About Your Factoring Costs (if
any) |
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| Monthly
Administrative Fee |
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| Expected
Monthly Factoring Amount |
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| Other
Fees: |
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| Are
You Under Contract With Your Current
Factor? |
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If
Under Contract, When Does Your Contract
Expires? |
| Yes
No |
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| Comments
: |
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