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Title With Company : --- Owner/CEO CFO SVP VP Accountant/CPA Attorney Banker Broker Other   Company : First Name :   Industry : Last Name :   City and State : Telephone :   Mobile : Email :   Fax :   TELL US ABOUT YOUR EXISTING FACTORING ARRANGEMENT:     Current (average) Monthly Factoring   Advance Rate 50%-55%  60%-65%  70%-75%  80%-85%  Term How Long Have You Been Factoring? Factoring Discount Fee Do you expect to Factor For at least Next 24 Months? Yes No Monthly Administrative Fee Expected Monthly Factoring Amount Other Fees:   Name of Current Factor     Are You Under Contract With Your Current Factor?  If Under Contract, When Does Your Contract Expires?  Yes No Comments :                        This is a non-binding inquiry.  If a factoring offer is made, you have no obligation to accept the offer. The representative that handles your region will contact you shortly. We hope to be your source for all your factoring needs. Thank you for submitting the online form.

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