Invoice Factoring Application

Invoice Factoring Application

Business Name(Required)

Date Established(Required)

EIN Number(Required)

Address(Required)

City(Required)

State(Required)

Contact Name(Required)

Title(Required)

Phone Number(Required)

Email Address(Required)

Business Description(Required)

Monthly Sales(Required)

Amount of Financing Requested(Required)

Are You Currently Being Financed? (Factor, Loans, Line of Credit, Merchant Cash Advance etc.) IF YES PLEASE INDICATE NAME:(Required)

Top 3 Customers(Required)

Based on Accounts Receivable Aging:

Customer Name

City & State

Monthly Volume

Owner Information(Required)

Please include all owners.

Name

Title Ownership

% Ownership

Home Address

City, State Zip

Phone Number

Social Security Number

Signature

Consent(Required)

All of the above statements are true and accurate to the best of my knowledge. By submitting this application, I/we understand and agree that Long Bay Capital and syndicate partners are authorized to make all inquiries, including background checks, it deems necessary to verify the accuracy of this application and to determine the creditworthiness of the applicant, applicant contact and/or the authorized representatives, principals, officers, members, partners, owners and/or guarantors associated with this application. I/we further understand and agree that if the application is approved, Long Bay Capital and syndicate partners are authorized to make further inquiries from time to time to verify the continuing creditworthiness of those identified herein in connection with the extension or continuation of the business credit represented by this application.

Name

This field is for validation purposes and should be left unchanged.

Invoice Factoring Application

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