Please complete the Short-Form below. The Representative that handles your region will contact you shortly. (International (NON-U.S.) Companies: Please Click Here to APPLY) GENERAL INFORMATION Legal Name of Business Type of Ownership Corporation S Corporation LLC Partnership Sole Proprietorship Other City and State 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 Type of Business (Industry) Select Your Industry Business to Business Distribution Fashion-Apparel Freight Broker Manufacturer Medical / Healthcare Printing Security / PI Firms Service Staffing Telecommunications Transportation Trucking Wholesale Distribution Other If Other, Explain Type of Products/Services Offered Name of CEO / Owner How Long In Business ABOUT ACCOUNTS RECEIVABLES Dollar Amount of Receivables Now Open 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? 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? ------------------------> 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 Thank you for submitting the online form. The person that handles your region will contact you shortly. By submitting this online form, you understand that you are providing this information for the sole purpose of assisting our Corporate Financial and Factoring Group Division or assigns with its initial evaluation of your request and does not represent or imply a commitment or obligation to provide factoring or financing. All requests are subject to final approval. Again, thank you.
Please complete the Short-Form below. The Representative that handles your region will contact you shortly. (International (NON-U.S.) Companies: Please Click Here to APPLY)
Are You Factoring Now or Factored in the past?
If Factoring Now
If Factored in the Past
Thank you for submitting the online form. The person that handles your region will contact you shortly. By submitting this online form, you understand that you are providing this information for the sole purpose of assisting our Corporate Financial and Factoring Group Division or assigns with its initial evaluation of your request and does not represent or imply a commitment or obligation to provide factoring or financing. All requests are subject to final approval. Again, thank you.