Business Information
Ownership Information
Consent Form
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Invoice Factoring Application
(Approximate time to complete: 5 to 10 minutes)
Corporation/Legal Name*
Doing Business As*
Contact Name*
Business Address*
City*
State*
Postal Code*
Fax Number*
Business Phone Number*
Mobile Phone Number*
Email Address*
Products or Services Sold*
Business Category*
Retail
Wholesale
Restaurant
Bar
Lodging
Manufacturing
Automotive
Medical
Services
Technology
Other
Total Monthly Volume*
Credit Card Processing Monthly Volume*
Average Ticket Amount*
Payment Methods Accepted*
Cash
Check
Wire/ACH
Visa/Mastercard
American Express
Discover
Choose all that apply.
Month/Year Established*
/
Length of Ownership*
/
Years/Months
Number of Employees*
Federal Tax ID*
Business Property*
Rent
Own
Square Footgae*
Monthly Rent/Mortgage*
Type of Entity*
Corporation
LLC
Sole Proprietorship
Partnership
LLP
Non-Profit
Choose one.
Landlord/Mortgage Company Name
Contact Name
Landlord Phone Number
Debtors*
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