InvoicestoCash.com
Online Factoring Application

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this form may not function properly for you.
AOL and web mail users should use the printable form.

Step 1. Tell us about your business

1. Legal name of business

Address

City
State
Zip
Telephone
( ) -
Fax
( ) -
E-mail
2. Business Type
Corporation
Partnership
Sole Proprietor 		3. Date Established
/
(month/year)
4. Avg. Monthly Sales
$ 		5. Federal Tax ID Number
6. Does the company have any Federal or State taxes past due?
Yes No

Describe your business in one sentence:

Step 2.Tell us about the owners & banking

7. Name of owner
Title
% of Ownership

Address

City
State
Zip
Telephone
( ) - 		Social Security Number
- -
8. Name of owner
Title
% of Ownership

Address

City
State
Zip
Telephone
( ) - 		Social Security Number
- -
9. Name of your bank
City
State
10. Does the anyone have a security interest in the accounts receivable?
Yes No
If yes to the above question:
Name of secured party
Telephone
( ) -

Step 3.Tell us about your customers

11. Please list your top three customers

Customer Name
Title

Address

City
State
Zip
Telephone
( ) - 		Monthly Volume
$
Customer Name
Title

Address

City
State
Zip
Telephone
( ) - 		Monthly Volume
$
Customer Name
Title

Address

City
State
Zip
Telephone
( ) - 		Monthly Volume
$
12. What is your monthly volume to be factored?
$
The above statements are true and accurate to the best of my knowledge. This serves as my permission for the release of any information to participants in the InvoicestoCash.com network regarding this application for the purpose of credit investigation. I hereby authorize any InvoicestoCash.com participating factor to investigate the credit of all parties listed above.
13. Name of person submitting Client Profile
Title


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