Commonwealth Loan Factoring Application

Apply Now! No application fee.

We would love to hear from you! Simply fill out this form and we will get in touch with you shortly.
Please make sure to verify your entries before submitting this applicatoin.

Date

Enter Today's date

Legal Company Name

Enter the legal name of the company here

DBA/Assumed Name

Enter the name you are doing business as

Contact Person

Enter the Person we should contact about this application

Title

Your Title

Street Address

P.O. cannot be used

Mailing Address

If different from Street Address

City, County, State, Zip

Telephone

with following format (xxx-xxx-xxxx ex: 123-456-7890)

Email*

Business Description*

Tell us a little about your business

How long have you been in business?

Tax ID#

Corporation Type

Corporation

LLC

LLP

Sole Proprietor

State Registered In

Date of Registration

President

SS#

Ownership Percentage

Address

Vice President

SS#

Ownership Percentage

Address

Corporate Secretary

SS#

Address

Treasurer

SS#

Address

Corporate - Are taxes up to date ?*

Yes

If No, Amount Due

Payroll Up to Date?*

Yes

If No, Amount Due

Personal Taxes Up to Date?

Yes

If No, Amount Due*

Bank name & Address

City

County

State

Zip Code

Account Officer

Telephone Number

Account#

Loan amount

Secured by

Average Size of Invoices

Average Monthly $ to be Financed

Are your receivables pledged elswhere?

Yes

If you answered yes, to whom?

Gross Sales Last Year*

Normal Terms of Sale*

Projected Sales in Current Year*

(1) List Current Customer You Wish to Factor

{1) Phone Number*

(1) Primary Business Address

(2) List Current Customer You Wish to Factor

{2) Phone Number

(2) Primary Business Address

(3) List Current Customer You Wish to Factor

{3) Phone Number

(3) Primary Business Address

More than three? Please give a number where we can contact you

You Acknowledge

by initialing below, you acknowledge that your initials will be used to process this on-line application. You will still be required to sign all final agreements and or paperwork in person.

Please place your initials in the space below*

Your Title

Today's Date

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Commonwealth Loan Factoring Application

Application (Factoring)

Apply Now! No application fee.

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