FRONTIER FUNDING APPLICATION

If you have multiple owners, please have each owner fill out a separate application.

COMPANY NAME *

OTHER TRADE NAMES AND DBAs

US DOT# *

MC# *

EMAIL *

example@example.com

PHONE *

OFFICE MANAGER NAME

FAX

BUSINESS ADDRESS *

CITY *

STATE *

ZIP *

BUSINESS TYPE *

Corporation LLC Individual/Sole Proprietor Partnership

STATE BUSINESS WAS FORMED IN *

YEARS IN BUSINESS *

CHECK ALL THAT APPLY

BACK TAXES JUDGEMENTS & LIENS LAWSUITS CRIMINAL CONVICTIONS

EXPLAIN WHY (if any of the above)

YEARS IN TRANSPORTATION INDUSTRY *

TYPE OF EXPERIENCE IN INDUSTRY *

DESCRIBE YOUR GROWTH PLANS *

I AM ALSO INTERESTED IN

FUEL CARDS FUEL ADVANCES

AMOUNT YOU INTEND TO FACTOR MONTHLY *

HOW SOON DO YOU INTEND TO START FACTORING? *

HAVE YOU OR ANY OWNER EVER FACTORED OR BORROWED AGAINST YOUR RECEIVABLES? *

YES NO

IF YES, WITH WHOM?

ARE YOU CURRENTLY IN A FACTORING RELATIONSHIP? *

YES NO

IF YES, WITH WHOM?

DO YOU HAVE A WORKING CAPITAL ADVANCE OR LOAN? *

YES NO

IF YES, WITH WHOM?

IF YES, WHAT IS THE CURRENT BALANCE?

Name *

Title *

Home Address *

City, State, Zip *

Cell Phone *

SSN *

DOB *

% OWNED *

Signature *

Clear

Date *

Date

If you have multiple owners, only one owner needs to submit the articles of formation, aging report, and currenty factoring agreement (if applicable).

Owner/Member Photo ID

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Articles of Formation/Incorporation (if applicable)

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Aging Report (or top 10 brokers with balances, if applicable)

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If Currently Factoring: Copy of Current Agreement (if applicable)

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The above statements are true and correct to the best of my knowledge and belief. This serves as my authorization to release information regarding the application for the purpose of credit investigation to Frontier Funding, Inc. and or is designees and assignees.

Owner Signature *

Clear

Date *

Date

Print Name *

Thank you for your interest in Frontier Funding!

STEP 1: ABOUT YOUR BUSINESS

STEP 2: ABOUT YOUR ACCOUNTS RECEIVABLE

STEP 3: OWNER'S INFORMATION

STEP FOUR: UPLOAD FILES

STEP FIVE: FINAL SIGNATURE(S)