| 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: |
|
