Finally! A Factoring Company That Is Flexible and Affordable

Please Complete the Online Factoring Request Information Form

Company Name *

Company Address *

Contact Person/Position: *

Telephone# *

Two best times to reach you: *

Fax#: *

Email Address: *

Product/Services that you sell *

Structure of Your Company *

Corp.

Sole

Partnership

Other

How Long In Business *

Monthly Sales($) Volume *

Annual Sales($) Volume *

Average ($) Invoice Size *

Number of Customers *

Bank Loans ($) *

Bank Loan Collateral (if any) *

Are you currently factoring, if so, with whom? *

Types of Customers *

Anything else you would like us to know

Thank you. We will respond to you within 24 hours,
if submitted on Sat. or Sun.,
we will respond by Monday.
Your information is secure and confidential.

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