Mike Davis Consulting Government Factoring Application

Average Monthly Sales:*

Current Open A/R $:*

Desired Monthly Funding Needs:*

Do You Bill in Progress Stages?

YesNo

Do You Hold Inventory for Clients?

YesNo

Selling Terms*

Customer #1 (Will NOT be Contacted)*

Customer #2 (Will NOT be Contacted)

Customer #3 (Will NOT be Contacted)

Do you have any Bank, SBA or MCA Loans?

YesNo

If Yes, list amount and Lender(s)

Do you have unpaid back taxes

YesNo

If Yes, Tax Balance $ and to Whom

Any Past/Pending Lawsuits, Judgements or Litigation?

YesNo

If Yes, describe litigation

Have You Factored Before?

YesNo

Owner's Drivers License(s)

Last 3 Months of Bank Statements

Open Invoice & Agin Report

Invoice Backup Documents

Purchase Orders and Time Sheets

Cancelled Check

Insurance ACORD Statement

Certificate of Insurance

Allowed File Types:

pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif

Note: If your files won't upload or drag, they may be to big. You can also email your files to finance@mikedavisLLC.com. Please attach or email the documents listed above to speed up receiving your funding proposal.

Signature*

Signature

Name*

Name

I/We attest that the statements in this application are true and correct to the best of my/our knowledge. I/We authorize Mike Davis Consulting, LLC and its assignees to verify any and all statements in this application in any way it may choose, and the right to procure credit reports of the principles of the applicant company.

Government Factoring Application

Owners & Officers with 10%+ Ownership

Selling Terms & Customers

Financial Information

Documents to Upload