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]]
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]
RE: Requesting Invoice Factoring
Hello Bob:
Attached is my application, call for additional information. I understand I may have to provide the following items:
- Last 2 years and Year to Date Financial Reports
- Current Aging Accounts Receivable
- Current Aging Accounts Payable report
- One of the Following Whichever is Applicable:
Articles of Incorporation or DBA Filing or Partnership Agreement or Business License
- List of Owners/ Principals /Partners & Percentage of Ownership
- 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:___________________________________________________________________