How to Run as Small Factoring Business
Application, page 2 Customers you wish to factor: Company Name Approx. Avg. Avg. Mo. Credit Company Address Size of Co. Type of Invoice Amt. Terms Avg. City, State, Zip ($ Sales/Yr) Business Amt. to Factor You Give Pmt. Time 1) 2) 3) 4) 3 Business References: Name Phone Business/Company Association with You 1) 2) 3) Other Information: Banking Information Name of Bank Branch Checking Acct # Contact Person Bank Routing # Phone # Professional References Name of Attorney Phone Name of Accountant Phone Agreed and consented to: Signature Print Name Title Date The foregoing information is true and correct to the best of my knowledge and is given to induce ABC Financial  Services to consider entering into a factoring agreement with this company. I hereby authorize ABC Financial  Services or its agents to verify and investigate any or all of the foregoing statements, including but not limited to  my/our credit worthiness and financial responsibility, in any way they may choose. I/We grant ABC Financial  Services the right to procure any and all credit reports pertaining to any party listed in this application, including, but  not limited to, all principals of the applicant company. (253) 555-5555 P.O. Box 9999 (253) 555-5554 Fax ABC Town, WA 99999 Date: Name: Title: Company Name: Phone: Address: Fax: City, State, Zip: Cell: Referred by: Email: Describe your company & the business you do:  Sole Proprietor        Partnership        LLC        Corporation    FEIN # How long in business/industry Factored before?  Yes     No Gross Revenue last 12 months Other Factor Name: Avg. volume to factor -  Monthly: Approx. # of customers: Annually: Approx. # to factor: % Yearly Growth: Range of Invoice Sizes: Avg. Invoice Size:  Please explain need in detail Taxes due or past due:  None  Local $  State $  Federal $ Litigation/Judgments:  Yes     No     (If Yes, please describe on separate sheet) UCC Filings:  Bank Loans: Collateral: Principals of Company: Officer Name  Title Home Addr. City, ST, Zip SS. # % Owned (continues on back) ABC Financial Services Application Form