FACTORING SHORT FORM GENERAL INFORMATION Legal Name of Business City State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Select Contact Name Your Position With The Company Attorney CEO CFO Controller COO CPA Director Executive VP Office Manager Owner President Sr. Vice President Vice President Assistant Vice President Other Select Email Phone Fax . COMPANY INFORMATION . Type of Business Please Make Selection Business to Business Distribution Manufacturer Medical / Healthcare Printing Telecommunications Transportation Trucking Service Staffing Wholesale Distribution Other If Other, Explain Type of Products/Services Offered Name of CEO How Long In Business Number of Employees Type of Ownership Corporation S Corporation Sole Proprietorship Partnership Limited Liability Company State of Incorporation (if applicable) Is Your Company Public or Private? Public Private . . ABOUT ACCOUNTS RECEIVABLES . 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? 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 MANY OTHER FACTORS HAVE SEEN THIS DEAL? HOW DID YOU HEAR ABOUT US? ------------------------> Please Select One Attorney Bank Other Lender Broker CPA CFG Client Alta Vista AOL Ask Jeeves Excite Google HotBot Jayde Lycos MSN Overture Yahoo YellowPages Other Our Corporate Factoring Group Division thanks you for submitting the online form. The person that handles your region will contact you shortly. You can expect a response within just a few hours, if not minutes. If your factoring volume is less than $500,000 a month, the application will be processed by our small business affiliate - lower fees still apply. We hope to be your source for all your factoring needs. Again, thank you.
FACTORING SHORT FORM
COMPANY INFORMATION
Are You Factoring Now or Factored in the past?
If Factoring Now
If Factored in the Past
Our Corporate Factoring Group Division thanks you for submitting the online form. The person that handles your region will contact you shortly. You can expect a response within just a few hours, if not minutes. If your factoring volume is less than $500,000 a month, the application will be processed by our small business affiliate - lower fees still apply. We hope to be your source for all your factoring needs. Again, thank you.