Our Company    > Contact Us    Privacy Policy >  Site Map

 
Home >  Factoring
   
     
 

 

 
APPLICATION FORM
APPLICATION TO ENTER INTO SECURITY AGREEMENT WITH USAFG FACTORS
BUSINESS NAME
DBA
ADDRESS
TELEPHONE
CITY  STATE  ZIP
TYPE OF BUSINESS
ESTABLISHED
INDIVIDUAL PARTNERSHIP CORPORATION
IF A CORP., WHAT STATE OF INCORPORATION?
OWNER OR OFFICERS:
Contact Person
Title
Phone
RECEIVABLES:
Receivables Open $
Aprox. Number of Customers
Terms of Sale
Average Mo. Sales Volume $
Average Mo. Numbers Invoices
Average Invoice Amount $
Average Turnover of A/R
High Credit for Individual Act. $
Regular Fin. Statements Prepared? How Often? Prepared Last?
Do any customers buy from you on a "Contra" account basis (example: you also buy goods from them)?
PRIMARY CUSTOMERS (optional):
Name
Regular Credit Limit /Monthly Sales
City State  Zip
Telephone
CUSTOMER #2
Name
Regular Credit Limit /Monthly Sales
City State  Zip
Telephone
CUSTOMER #3
Name
Regular Credit Limit /Monthly Sales
City State  Zip
Telephone
CUSTOMER #4
Name
Regular Credit Limit /Monthly Sales
City State  Zip
Telephone
EXISTING FINANCING:
Yes No
To Whom:
Contact Name
Phone
COLLATERAL SECURING THE LOAN:
Equipment
A/R
Inventory
Real Estate
Other
 
By submitting this application electronically, the undersigned certifies the following: that the information set forth in this application and in the documents, schedules, reports, statements, and/or other information provided to USAFG Factors with or pursuant to this application are full, true, correct and complete and accurately reflect such information on the date(s) thereof; that USAFG Factors is authorized to request, receive and verify credit reports and other financial information regarding applicant and its business that USAFG Factors deems necessary or appropriate; that USAFG Factors is authorized to inquire of, investigate, confirm and verify any information contained in this application, in any documents, schedules, reports, statements and/or other information provided under or pursuant to this application, or learned by USAFG Factors as part of its investigation and review of this application, applicant, or applicant's business.
Dated:

 

  

 

 

 

 

  Contact USA Financial Group | Our Company | Privacy Policy

 Copyright USA Financial Group 1995-2003