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Business information

Corporation Partnership LLC Sole Proprietorship Other
306090
If yes explain
If yes, please provide the names If yes, explain:
If yes, explain: If yes, with whom?
If yes, explain: If yes, please explain:

Owners/Managers/Principals

Have the owners/shareholders/principals/Manager ever

Owned or been part owner in another company Yes No

Been convicted of a felony Yes No

Had any judgments or liens against them Yes No

Had pending lawsuits against them Yes No

Filed for bankruptcy Yes No

Filed a UCC against them Yes No

 

Explain:

Explain:

Explain:

Explain:

Explain:

Explain:

BUSINESS CREDIT INFORMATION

Yes No
Yes No
If there are any additional loans, please provide details in a separate sheet of paper.

ACCOUNTS RECEIVABLES INFORMATION

Yes No
Yes No ACH Wire-transfer Check Other
If applicable, does the applicant have contracts that include clauses allowing passing through increases in Cost of Goods Sold (COGS)? (i.e. raw materials, fuel, insurance, etc): Yes No

BUSINESS REFERENCES

Name of Contact: Email: Phone:
Company Name: Length of Relationship (months, years):
Business relationship: Supplier Customer Other:
Name of Contact: Email: Phone:
Company Name: Length of Relationship (months, years):
Business relationship: Supplier Customer Other:
Name of Contact: Email: Phone:
Company Name: Length of Relationship (months, years):
Business relationship: Supplier Customer Other:

OTHER INFORMATION

Applicant's Bank Name:
Email: Phone:
Account Manager Name Length of relationship (months, years):
Address: City/State/Zip:
Applicant’s Accountant Name: email: Phone:
Address: City, State, Zip:

FOR FEDERAL GOVERNMENT CONTRACTORS

I understand that the submission of an application for factoring with Factor Group, LLC does not mean that Factor Group, LLC will factor or provide any financial services whatsoever. I further understand that approval to factor will come only after the Factoring Agreement and all supporting forms have been signed and approved by Factor Group, LLC.
I certify the accuracy of the information provided and understand that Factor Group, LLC will be relying on the accuracy of this information when evaluating the company’s application. By submitting this application either by mail, fax, or electronically, the company authorizes Factor Group, LLC to use any credit bureau or business to verify the validity and accuracy of all information contained herein. I consent to Factor Group, LLC’s filing of one or more Initial Financing Statements against me or the undersigned company in any or all Uniform Commercial Code jurisdictions, which reflect the collateral as “all assets.”All the information provided is confidential and for the sole purpose of evaluating the factoring application.

In order to process your application, please enclose the following documents:

  • Detailed Current Accounts Receivable Aging Report aged by Invoice Date.
  • Detailed Current Accounts Payable Aging Report aged by Invoice Date.
  • End of the year A/R and A/P Aging Reports (last 2 years).
  • Year-to-date Financial Statements (both income statements and Balance Sheets).
  • Last two (2) years Financial Statements.
  • Last two (2) years of income Tax Returns.
  • Sample of common transactions documents (i.e. Purchase Orders, Invoices, Proof of Delivery to Customer, Contracts, etc).
  • Driver's Licence of all Owners/Managers/Principals.
  • Copy of DBA Filling(s) if applicable.
  • Copy of Articles of Incorporation or Articles of Organization if LLC.
    Enclosed documents to be completed:

  • Signed Factoring Application.
  • Signed Company Certificate and Resolution.
  • Completed client List Form.

    Additional Information:

    For Corporations:
  • Copy of any Shareholders Agreement
  • Copy of any By-Laws.

    • For Limited Liability Companies:
  • Copy of an written Operating Agreement.

Account List: Please provide your current costumer list. For those accounts that you wish to factor also provide the additional information required below.

Client name list - Information required for accounts to factor.

Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:
Company Name: Terms: Monthly Sales: $
Address: Contact Name: Phone: City/State/Zip Code: Length of Relationship:

Please Note: There is $150.000 one time Application fee wich must be submitted with this Application prior to processing and $50.00 per each customer to be evaluated. Please make check payable to : "Factor Group, LLC."

Please send your completed documentation to:
Factor Group LLC, Phone 786-235-4220 , E-mail: usa@factorgroup.com, Address 1000 NW 57th Court, Suite 350 Miami, FL 33126. For additional information visit www.factorgroup.com



 

  

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