Personal Information Let's get to know you better! Provide your personal information to kickstart the journey towards your business loan. We'll make it quick and easy! Legal First Name* Legal Last Name* Email Address* Phone Number* Business Owner’s Date of Birth* Business Owner’s Social Security Number* Business Owner’s Driver's License Number* State Issued* Expiration Date* Back | Next Business Information Your business is our priority! Share the details about your company to unlock the best lending solutions tailored to your needs. Let's propel your business to new heights! Business Name* DBA Name Business Address* Federal/State Tax ID Year Established Company Website/Owner's Email Address State of Incorporation DUNS Number Entity Type Name of Business Owner (If different from applicant) Business Owner’s Title Business Owner’s Home Address Percentage Ownership Back | Next Financing Details Great things are ahead! Provide the financing details for your business loan, and we'll work our magic to connect you with the perfect funding option. Your success is our mission! Type of Financing Requested Length of Financing Purpose of Financing Business Loan Type Amount Requested Gross Annual Sales Average Monthly Sales Lease or Mortgage YesNo Lease/Mortgage Payment Landlord/Lender Name Landlord/Lender Contact (Phone or Email) Back | Next Client Factoring Application Step 1: General Information Provide the following details: Number of Employees * Do you use a Payroll Service? * YesNo If yes, Name of Service Nature of Business/Primary Product (Service) * Factored or pledged receivables in the past? * YesNo Balance Owed Is the company current on all taxes? * YesNo If Yes, Balance Owed Has the company ever filed Bankruptcy? * YesNo If yes, Date Any unpaid liens or judgments? * YesNo If yes, Balance Owed Any active or pending lawsuits? * YesNo If yes, Liability Any change in Ownership in the past 24 months? * YesNo If yes, Balance Owed Previous Next Client Factoring Application Step 2: Transportation Industry Provide the following details: Transportation Industry * CommonContractBrokerageOther Motor Carrier # # of Co. Trucks # Owner Operators % Broker Loads Previous Next Client Factoring Application Step 3: Bank Information Provide the following details: Bank Name * Account Number * Phone Branch Location Contact/Officer Name Email Fax Previous Next Client Factoring Application Step 4: Ownership Information Provide the following details: Have any of the above Owners been Convicted of a Felony? * YesNo If yes, What Date Any of the above Owners filed for protection under Bankruptcy? * YesNo If yes, Who Date Previous Next Client Factoring Application Step 5: Account Receivable Information Provide the following details: Total Outstanding Accounts Receivable Average Number of Invoices Per Month Average Invoice Amount Total Billings Last 30 Days Total Billings Last 12 Months Annual Bad Debt Write Offs Normal Sales Terms Annual percentage of returned sales Have installment or progress billings? YesNo Any Consignment Sales? YesNo Any Bill and Hold Sales? YesNo Sell to the government? YesNo Sales from Construction Work? YesNo Conduct Foreign Export Sales? YesNo Work completed before invoice customer. YesNo Sell to Consumers? YesNo Sell to Related Companies or Affiliates? YesNo Make purchases from your customers? YesNo Offer a Warranty or Guarantee? YesNo Return of Goods require prior approval? YesNo Grant Extended Terms to customers? YesNo Do you bill by Statement? YesNo Are you required to collect Sales Tax? YesNo Sell to any of your Stockholders? YesNo If you answered yes to any of the above, please provide explanation Who referred you to us? Previous Next Client Factoring Application Step 6: Supporting Documentation Please include the following with your document: Current and last month's ending accounts receivable aging Current and last month's ending accounts payable aging Master customer list with contact details Sample of 3 invoices with supporting documentation (i.e., contracts, purchase orders, time sheets, POD's) Company's last 2 financial year-end statements with corresponding tax returns and current interim Personal financial statement and last filed tax return for each owner All Entity Documents Copy of ID for each owner (driver's license/passport) Current general liability and property insurance certificate Previous