INTEGRATED FACTORS

INTEGRATED FACTORS
Email: submissions@Integratedfactors.com
Business Information
Business Legal Name*
Legal Entity Type*

CorporationLLCSole Proprietership
Doing Business As*
Business Phone*
Federal Tax ID*
Business Best Contact Number
Email Address*
example@example.com
Business Fax
Business Website
Business Address*

Mailing Address

Street Address Line 2

CityState

Zip Code
Business Start Date*

MonthDayYear
Date
Owner Information
Name*
Email*
example@example.com
Home Address*

Home Address

Street Address Line 2

CityState

Zip Code
of Ownership*
Mobile*
Date of Birth*

MonthDayYear
Date
2nd Owner Principal Information
Social Security
Name
of Ownership
Email
example@example.com
Address

Home Address

Street Address Line 2

CityState

Zip Code
Mobile
Date of Birth

MonthDayYear
Date
Social Security
Additional Information
Business Description*
How much are you billing a month in b2b or b2g invoices?*
What is your average invoice size*
What Terms do you Offer Your Customers (i.e. net 30 net 45)*
Gross Annual Sales Last Years Tax Return*
Total Monthly Sales All Forms of Revenue*
Are your receivables currently encumbered by a UCC If so With who*
Is the Business or Owner in an Open Bankruptcy*
Document Upload

Please Upload the Following: 6 months business bank statements, drivers license, voided check, detailed A/R report, Sample Invoice, and Articles of Incorporation/Organization
Cancelof
Authorization Form The Merchant and Owner(s)/Officer(s) identified above (individually, an "Applicant") each represents, acknowledges and agrees that (1) all information and documents provided to Integrated Factors including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Integrated Factors of any change in such information or financial condition, (3) Applicant authorizes Integrated Factors to disclose all information and documents that Integrated Factors may obtain including credit reports to other persons or entities (collectively, "Assignees") that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Invoice Factoring transactions, including without limitation the application therefor (collectively, "Transactions"), and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) Integrated Factors and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Integrated Factors Assignees, and each of their Integrated Factors, successors, assigns and designees (collectively, "Recipients") are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant. A copy of this authorization may be accepted as an original. The term "Integrated Factors" shall mean any representative providing funding sources and looking to offer, make available, or provide to the Merchant access to loans, Invoice Factoring, or other types of Accounts Receivable Financing.
Owner 1 Signature*

Clear
Print Name*
Date*

MonthDayYear
Date
CoOwner Signature

Clear
CoOwner Name
*Note: All Fields Are Required on this Application before Submission.

INTEGRATED FACTORS

Business Information

Owner Information

Additional Information

Customer Information