Factoring Application
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FIRST CAPITAL FUNDING
Fax: 732-635-1542
Email: OneCapFund@aol.com
Legal Company Name:____________________Date Established:____________
Present Address:________________________________________
City:____________________State:________________Zip:____________
Phone Number:________________________Fax Number:________________
Company Type (Corp./Partnership/Proprietorship):________________________
Federal ID No. or Social Security No.:________________________________
Annual Sales Volume (last two years):________________No. of Employees:________
Type of Business (Manuf./Publishing/Distribution/etc.):________________________
Type of Clients (Retail./Hospitals/Distribution/etc.):________________________
Terms of Sale (net 30/COD/etc.):________________No. of Clients:____________
List any accounts receivable pledged as collateral:________________________
________________________________________________
List any judgements or liens filed against you:____________________________
How did you hear about our company:________________________________
Approximate annual dollar amount of bad debt write-off (last 2 years):________________
Estimate of annual volume of accounts to be factored:________________________
Estimate of frequency of factoring:________________________________
Have you ever factored before:________If yes, with what company:____________
List of applicant’s outstanding loans, if any, is as follows:
Loan start date:________Lender Name________________Amount________Collateral
____________________________________________
____________________________________________
____________________________________________
The following is General Information:
Name of Attorney:________________________Phone:________________
Name of Accountant:________________________Phone:________________
Do you own or lease space:____________________Monthly payment:________
Name of Landlord/Management Company/Lender:____________Phone:____________
Address of Landlord/Management Co./Lender:____________________________
Period of lease/payments:____________________________________
Personal Information on Officers, Partners, or Guarantors:
* Require Minimum of President and Secretary of Corporation *
Name 1:________________________Position:________________
Social Security Number:____________________Date of Birth:________________
Home Address:________________________Home Phone No.:____________
Name 2:________________________Position:________________
Social Security Number:____________________Date of Birth:________________
Home Address:________________________Home Phone No.:____________
Company Bank References - Two Year History:
* Important to establish loan history *
Bank Name 1:________________________City/State:________________
Contact Officer:____________________Phone:____________________
Checking Account No.:____________________Loan Account No.:____________
Bank Name 2:________________________City/State:________________
Contact Officer:____________________Phone:____________________
Checking Account No.:____________________Loan Account No.:____________
Trade References - Two Year History:
* Important to establish high credit and payment history *
Supplier Name 1:________________________________________
Address::____________________________________________
Contact Person:________________________Phone:____________________
Supplier Name 2:________________________________________
Address::____________________________________________
Contact Person:________________________Phone:____________________
Supplier Name 3:________________________________________
Address::____________________________________________
Contact Person:________________________Phone:____________________
Authorizing Signature:
* REQUIRED IN ORDER TO PROCESS REQUEST *
Authorizing Officer:____________________Phone:____________________
I/We hereby authorize you, to whom this application is made, or your agents, to investigate my/our financial responsibility and creditworthiness and will provide financial statements, tax returns, etc., as you deem necessary. I/We grant First Capital Funding the right to procure any and all credit reports pertaining to any party to this application.
First Capital Funding
(732)635-1545
Fax: (732)635-1542