Invoice Factoring - Intake Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name
EIN
Business Website or Social Media
What does your business do?
Do you invoice other businesses (Factoring is typically for B2B businesses only)
Yes
No
What are your typical payment terms?
Net 15
Net 30
Net 45
Net 60
Net 90
Other
Do you invoice only after goods/services are fully delivered?
Yes
No
Approximate monthly invoice volume
Under $10,000
$10,000 - $50,000
$50,000 - $100,000
$100,000+
Other
Number of active customers you invoice
Please Select
1-2
3-5
6-10
10-20
20-50
50+
Do you have any existing loans or liens on your receivables?
Yes
No
Not sure
File(s) Upload (AR Aging report, Invoices, PO, Contract)
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Additional notes or comments:
Signature
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