Application to enter into a Security Agreement for Financial Services
Does the business use a fictitious name?
Articles of Incorporation and or fictitious business name filing is hereby provided
*List all members who own 20% or more of the company*
How often do you file 941 payroll taxes?
Do you have any Federal or State taxes past due?
Do you use pay roll services?
BUSINESS CHECKING ACCOUNT
ACCOUNTS RECEIVABLE INFORMATION
Are you factoring now or have you factored before?
Are your accounts receivable pledge as collateral?
Any other commercial loans/leases outstanding?
LIST OF PRINCIPAL SUPPLIERS
Are you presently leasing your business space?
Name of landlord and/or management company:
Are you currently under the protection of the United States Bankruptcy laws?
(Known for at least 2 years)
This serves as my permission for the release of any information regarding this application for the purpose of credit investigation. Please begin the verification and remittance address change process for the accounts receivable submitted to you in order for us to qualify as a client . The above statements are true and accurate to the best of my information and belief.