EmailMeForm
PURCHASE ORDER & INVOICE FACTORING
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"SEE ATTACHED" IS NOT AN ACCEPTABLE ANSWER. ALL FIELDS MUST BE COMPLETE.
Submissions that state “See Attached” or have missing information will be considered incomplete and applicant will be required to re-submit the form.
Enter all amounts in $USD.
Briefly describe what the borrowing company does:
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How much capital is being requested?
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Breakdown the use of the loan proceeds:
("See Attachment" is not an acceptable answer.)
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Where is the borrowing company located?
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City/Town
State/Region
Country
Year company began:
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Personal Credit Scores of the Principal(s):
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Total Accounts Receivable now:
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Accounts Receivable over 90 days old:
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Total Accounts Payable over 90 days old:
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Approximately how much are you billing per month?
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Credit terms extended:
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30 days, etc.
Is the business seasonal?
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Yes
No
What % of sales are performed under contract with progress billing?
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Are there any tax delinquencies?
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Yes
No
What % of customer base is outside U.S.A?
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Does any customer account for more than 25% or A/R?
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Yes
No
What is the current company net worth?
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Estimate the liquidation value of Inventory (excluding work in progress):
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Estimate the liquidation value of Equipment:
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furniture and telephone/computer equipment is not acceptable collateral
If the equipment has been appraised, for how much?
If no appraisal, leave blank
Date of Appraisal
If no appraisal, leave blank
Type of Appraisal:
Please select
FMV (Fair Market Value)
OLV (Orderly Liquidation Value)
FLV (Forced Liquidation Value)
No Appraisal
Appraised/Estimated value of business owned Real Estate:
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Estimated value of any other business assets:
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Total secured debt (including mortgage) against company now:
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Monthly payment now on secured debt:
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Are the payments current?
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Yes
No
2024 Revenue:
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2024 Net Income:
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2023 Revenue:
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2023 Net Income:
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2022 Revenue:
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2022 Net Income:
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This year's projected sales volume:
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Amount of backlogged orders now:
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Is the business currently making money?
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Yes
No
If making money, for how many consecutive months?
if not making money, enter 0
Does company have accountant prepared financial statements?
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Yes
No
If so, when does the accounting year end?
What type of statement?
Select One
Audited
Reviewed
Compiled
No Statements Available
Who does the company typically sell products/services to?
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If you have any orders placed by clients that are pending, please briefly describe them below and Attach proof of the order(s) below.
Additional Comments, if any:
File Upload
ALL QUESTIONS MUST BE ANSWERED
Submissions that state “See Attached” or have missing information will be considered incomplete and applicant will be required to re-submit the form.
Sample invoice which includes back-up (supplier invoice, proof of delivery, contract with customer, Purchase order from customer)
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Accounts Receivable Aging report
Accounts Payable Aging report
Upload proof of future client orders here (if any).
Signature
Name of person completing form:
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Phone:
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Email:
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Confirm
Person completing the form is:
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Broker
Principal Borrower(s)
Other
Referral Information (if applicable)
Name of person who referred you to us:
Email of person who referred you to us:
Account Executive (if applicable)
If you have been assigned an Account Executive (other than the person who referred you), please enter their email here.
