Invoice Factoring Application This invoice factoring application will gather some information about you and your business. It generally takes about 5 minutes to complete. There are no fees and no obligations to apply. Of course, any questions, at any time, simply contact us. We look forward to working with you! * All fields are required Unique IDPersonal InformationName* First Last Email* Phone*Job title* How did you hear about us?*AffiliateEmailInternet SearchFriendOtherAffiliate ID* Prior personal or business bankruptcy?*-- Select --NoYesEstimated credit score* Social security number Percentage of ownership Business InformationLegal business name* DBA (if different) Business phone*Business address* Business city* Business state*-- Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioQuebecPrince Edward IslandSaskatchewanBusiness zip code* Website* Legal entity type*-- Select --CorporationGeneral PartnershipLimited Liability CorporationLimited Liability PartnershipNon-ProfitSole ProprietorshipState of incorporation*-- Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaNew BrunswickBritish ColumbiaManitobaNova ScotiaNewfoundland and LabradorOntarioPrince Edward IslandQuebecSaskatchewanBusiness start date* MM slash DD slash YYYY Business tax ID* Are any federal or state taxes past due?*-- Select --NoYesIs the business in active bankruptcy?*-- Select --NoYesIs there any judgment or pending litigation against the company or any principal?*-- Select --NoYesWhat products and/or services do you offer?* Who are your customers?*-- Select --BusinessGovernmentBusiness & GovernmentGross monthly revenues*How long does it take for your customers to pay on average?*-- Select --30 days or less60 days90 daysOver 90 daysWhat is your total outstanding Accounts Receivable balance?*How soon do you need factoring?*-- Select --ASAP30 days> 30 daysDo you currently have other financings?*-- Select --YesNoLender name* Document UploadUpload a copy of your current Accounts Receivable aging report*Max. file size: 2 GB.Upload a copy of your current Accounts Payable aging report*Max. file size: 2 GB.Upload a copy of the most recent monthly business bank statement*Max. file size: 2 GB.Consent* By submitting this application, you (i) authorize BorrowPartner LLC and/or its lending partners to use any credit bureau or business to verify the information that you provided, (ii) consent to receiving calls from BorrowPartner at the telephone number that you provided above, even if it is on a state, federal, or corporate Do-Not-Call registry, (iii) agree with BorrowPartner's Terms and Conditions; and (iv) acknowledge that you have read BorrowPartner’s Privacy Policy.Applicant's Full Name* Date*
