Quick Application

Quick Application
Business Name:
Contact Name:
Title:
Street Address:
City:
State / Zip:
Telephone:
Extension:
Facsimile:
Email:
Web site:
How did you find us?
If "Other" please describe:
Description: Please provide a brief description of your company.
Are Your Customers:	Domestic Import Export

What is your average monthly sales volume? $
How much of your average monthly billing do you wish to factor? (%)
Have you ever factored/financed your receivables?	Yes No

If yes, with whom:

Total Accounts Receivable: $
Receivables > 90 days from invoice date: $
Does the Company or its Owners have any judgments or liens filed against them?	Yes No
Does the Company or its Owners have any pending law suits against them?	Yes No
Do you have any outstanding loans?	Yes No

If yes, with whom: Name of Financial Institution
Balance Owed: $

Do you have any UCC Filings:

Yes No

If yes, with whom:

Or are your receivables pledged as collateral:

Yes No

Please List Company's 5 Largest Customers You Wish To Factor/Finance (Note: Customers will NOT be contacted initially)
Company Name:
Address:
City:
State / Zip:
Monthly Sales: $
Average Invoice Amount: $
Company Name:
Address:
City:
State / Zip:
Monthly Sales: $
Average Invoice Amount: $
Company Name:
Address:
City:
State / Zip:
Monthly Sales: $
Average Invoice Amount: $
Company Name:
Address:
City:
State / Zip:
Monthly Sales: $
Average Invoice Amount: $
Company Name:
Address:
City:
State / Zip:
Monthly Sales: $
Average Invoice Amount: $
Message:
I am interested in:	Domestic Factoring Purchase Order Financing Government Factoring Construction Factoring Business Loans Trade Financing
I/We for ourselves and as owner(s)/officer(s)/partner(s)/guarantor(s) of the Applicant certify to Capital Finance that all of the information set forth in this Application (and in any other documents submitted in connection with this Application) may be relied upon by Capital Finance as being true and correct. I/We agree to promptly notify Capital Finance of any changes. I/We understand that this Application and attachments will remain the property of Capital Finance, even if the financing is declined. I/We for ourselves and as owner(s)/officer(s)partner(s)/guarantor(s) of the Applicant authorize Capital Finance to obtain any information Capital Finance requires relating to my/our creditworthiness from any source, including a credit reporting agency, any time during the term of the financing or while any balance is outstanding or if Capital Finance updates, renews or extends this financing. I/We for ourselves and as owner(s), officer(s), partner(s), guarantor(s) of the Applicant certify that the proceeds of this financing, if approved, will be for business use only. Agree To Terms: Yes No

"Bonded and Licensed California Commercial Finance Lender"

Contact Information:

Expert Witness Site - click here

All Pages Copyrighted © 2006-2008 Capital Finance - All Rights Reserved
Last modified: 1/21/08

"Bonded and Licensed California Commercial Finance Lender"

Contact Information:

Expert Witness Site - click here

All Pages Copyrighted © 2006-2008 Capital Finance - All Rights Reserved Last modified: 1/21/08

All Pages Copyrighted © 2006-2008 Capital Finance - All Rights Reserved
Last modified: 1/21/08