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factoring factoring factoring factoring factoring
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GENERAL INFORMATION
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Legal Name of Business
City and State
Contact Name
Your Position With The Company
Email
Phone
Type of Business (Industry)
If Other, Explain
Type of Products/Services Offered
Name of CEO / Owner
How Long In Business
. .

ABOUT ACCOUNTS RECEIVABLES
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Dollar Amount of Receivables Now Open
What Percentage % Temporary Placement   % Permanent Placement
Total Sales Last 12 Months
Approximate Number of Customers
Do You Sell on Terms of Net: 10 days 30 days 60 days 90 days
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

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BACK OFFICE SERVICES: Interested in Back Office?

Yes No  
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HOW DID YOU HEAR ABOUT US?   ------------------------>

Thank you for submitting the online form and for the opportunity to provide you and your company with excellent Staffing Factoring Services. Our staffing specialist that handles your local area will contact you shortly.