Camel Full Application

Camel Financial Application
Application to enter into a Security Agreement for Financial Services
Does the business use a fictitious name? *
Type of business? *
Articles of Incorporation and or fictitious business name filing is hereby provided

PRINCIPALS

*List all members who own 20% or more of the company*

*

Support Information

General Information

How often do you file 941 payroll taxes? *
Do you have any Federal or State taxes past due? *
Do you use pay roll services?

Banking Information

BUSINESS CHECKING ACCOUNT

BUSINESS LOAN ACCOUNT

PERSONAL ACCOUNT OF

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?

Supplier Information

LIST OF PRINCIPAL SUPPLIERS

Name

What do they supply?

Phone

Customer Information

Name

Address

Phone

Credit Line

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?

Personal References

(Known for at least 2 years)

Name

Address

Phone

Business References

(Customers Only)

Company Name

Individual

Address

Phone

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.