Factoring  Application

 

FACTORING - CLIENT PROFILE WORKSHEET

 

 

COMPANY INFORMATION (Required)

 

Legal Name of Company on Articles of Incorporation: ____________________________________________

 

DBA if applicable: _________________________________________________________________

 

Address:______________________ City:_______________ State:____ ZIP_________

 

Phone:____________________    Fax: __________________ e-Mail: __________________________

 

Federal Tax ID # _____________ Number of Employees: _________

 

Legal form of business:   ___ Corporation     _____Partnership     ___ Proprietorship    ___ LLC

 

Date Business Started: ___________ State of Incorporation/Registration: ________________

 

Described Type of Business: __________________________________________

 

CORPORATE OFFICERS / PARTNERS / OWNERS (if more than three, please attach separate page) (Required)

 

Name: ____________________________ Title: __________ Ownership % _____

 

Home Address: ___________________________________________________

 

City: _________________________________ State: _______ ZIP: __________

 

Phone:________________ SS#:_______________ Driver's license #_________________State Issued: ____

 

Name: ____________________________ Title: __________ Ownership % _____

 

Home Address: ___________________________________________________

 

City: _________________________________ State: _______ ZIP: __________

 

Phone:________________ SS#:_______________ Driver's license #_________________State Issued: ____

 

Name: ____________________________ Title: __________ Ownership % _____

 

Home Address: ___________________________________________________

 

City: _________________________________ State: _______ ZIP: __________

 

Phone:________________ SS#:_______________ Driver's license #_________________State Issued: ____

 

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BOB  MOORE - Cash Financial Services - www.invoicestocash.com[email protected]

Phone 695-0331 – fax toll-free 866-383-4120

 


Factoring Application – Client Worksheet

 

ACCOUNTS RECEIVABLE INFORMATION (Required)

 

Are receivables generated from sale of goods, sales of services, or both? _____ Goods    ___ Services     ___ Both

 

Number of Active Customers: _______    Number of invoices per month: _______

 

Normal Selling Terms: ________________    Are any extended terms Granted? ___ No    ___ Yes

 

What is your Average Monthly Sales Volume? $___________  Annual Sales $___________

 

How much of your Monthly Billing do you wish to factor? $___________

 

Do you require Purchase Orders from your Clients? ______ What other documentation do you require?

 

Have you ever factored your Receivables?   ___ No ___ Yes, if yes with whom? ____________

 

Are you still submitting invoices? ___Yes     ___ No     Reason for leaving:

 

Does the Applicant or its Principle(s) have any pending lawsuits against them? ___ No    ___ Yes

 

If yes, please explain: _________________________________________________________

 

Does the Applicant or its Principle(s) have any outstanding loans?  _____ No    ___ Yes   

 

If yes please explain? _____________________________________________________________

 

Lender            Amount Outstanding          Collateral            Contact Person               Telephone

 

 

 

 

 

BANK  REFERENCES

 

Bank Name:  ______________________________________Account #: ______________________________________

 

Contact Name:______________________________________ Phone: _________________________________________

 

Bank Name:  ______________________________________Account #: ______________________________________

 

Contact Name:______________________________________ Phone: _________________________________________

 

 

 

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BOB  MOORE - Cash Financial Services - www.invoicestocash.com[email protected]

 

Phone 580-695-0331 – fax toll-free 866-383-4120

 

 

 

Factoring Application – Client Worksheet

 

 

CLIENT LISTING (Required)

Please list your 7 largest customers

 

[[PASTING TABLES IS NOT SUPPORTED]]
[[PASTING TABLES IS NOT SUPPORTED]]

 


Accountant:  __________________________  Phone:  __________________  Fax:  ____________________


 


Insurance Agent:  ______________________  Phone:  __________________  Fax:  ____________________


 


Attorney:  ____________________________  Phone:  __________________  Fax:  ____________________


 


The undersigned Officer, on behalf of the Company and individually, represents and warrants that all information on this Application is true and correct. I understand this is not an application for credit. The intent of this profile is for you to determine if a relationship between our two companies would be mutually beneficial. I authorize you to investigate the information I have supplied you with on this profile. I further authorize you to access any credit reporting agencies for which you or your affiliates, agents are a member of in your investigation of my company or me.


 


COMPANY:  _______________________________ (Required)    DATED:  ______________________________


 


President's / Principal's name:  (Printed) _______________________________________________ (Required)


 


President's / Principal's signature:  ____________________________________________________


 


SUPPORT INFORMATION (Required For Proposal):


Most recent balance sheet and income statement


Most recent detailed Accounts Receivable Aging Report


Most recent detailed Accounts Payable Aging Report


Last year's balance sheet and income statement


 


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Fax toll-free to 866-383-4120


 


BOB  MOORE


Cash Financial Services


www.invoicestocash.com[email protected]


Phone 580-695-0331


Date: _________________________


 


FAX Application toll-free to 866-383-4120


 


Bob Moore


President, Cash Financial Services


Brookhaven Square – 3509 Brookford Drive, Norman, OK  73072


Phone 580-695-0331


Web:  www.invoicestocash.com                                  Email:   [email protected] or [email protected]


 


RE:         Requesting Invoice Factoring


 


Hello Bob:


 


Attached is my application, call for additional information.  I understand I may have to provide the following items:


  1. Last 2 years and Year to Date Financial Reports


  1. Current Aging Accounts Receivable


  1. Current Aging Accounts Payable report


  1. One of the Following Whichever is Applicable:



Articles of Incorporation or DBA Filing or Partnership Agreement or Business License


  1. List of Owners/ Principals /Partners & Percentage of Ownership


  1. Legible Copies of Drivers Licenses for all Owners/ Principals /Partners


 


 


Company Name:______________________________________________________________


 


 


Point of Contact Name:_________________________________________________________


 


 


Address_____________________________________________________________________


 


 


City, State Zip________________________________________________________________


 


 


Web___________________________ Email _______________________________________


 


 


Phone _________________________ Fax _________________________________________


 


 


Cell __________________________ Home phone __________________________________


 


 


Comment:___________________________________________________________________