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Documents |
Enclosed |
Required |
Application Form |
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Factoring agreement |
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Photocopy of Articles of Incorporation |
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Consent from Last corporate Tax Return |
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List of customers of prospective client |
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Latest aging REPORT. (No more than 30 Days old) |
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Financial statement or cash flow reflecting THE
PAST 6 months |
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New Account Processing Fee-Cheque in the Amount of
$125.00 |
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APPLICATION FORM
Company Name Trade
Name
Building Address
Telephone Number Fax Number
Corporation0 Partnership0 sole Proprietor0 Other0
Years Established Type of Business
Describe Business
Head Office Address
Subsidiary of Credit Limit Desired $
BANK REFERENCE
Bank Name
Account #
Address
Telephone #
Bank Contract:
TRADE CREDIT
REFERENCES:
Vendor Name
Account #
Telephone #
Address
Vendor Name
Account #
Telephone #
Address
Date Authorized Signature Printed Name and Title
CORPORATE BANK INFORMATION
Name of Bank How long with Bank
Address
Telephone# Previous#
City Province Post
Code
Account# Name of Bank Officer
FACTORING
AGREEMENT
GENERAL BACKGROUND INFORMATION
Business Name
(As shown in the Articles of Incorporation)
Address
City Province Post
Code
Telephone#
Date Established / / Type
of Business
If operating in more than one location, state address of Head Office
Address
Does the business use a trade name? Yes No If yes, what is it
Where is the trade name registered?
Is the business incorporated ? Yes No If yes, is it Federal or Provincial?
SHAREHOLDERS AND OFFICERS
President/Partner Name Home Phone
% Owned Address
Social Insurance Number
Driver License Number Date
of Birth / /
Secretary/Partner Name Home Phone
% Owned Address
Own0 Rent0
Social Insurance Number
Driver License Number Date
of Birth / /
FEDERAL AND PROVINCIAL TAX INFORMATION
Are you current with
your:
Federal and Provincial Tax? Yes0 No0 If no, amount in arrears $ Period
Employee Deductions? Yes 0 No0 If no, amount in arrears $ Period
ACCOUNTS RECEIVABLE INFORMATION
Total amount of receivables open: Average Monthly Sales $
Approximate number of active accounts: Terms of sale $
Are you factoring now or have you ever factored before? Yes0 No0
If yes, with what company?
Are your receivables pledged as collateral? Yes0 No0 If yes to whom
What is the amount you intend to factor on a monthly basis? $
The above statements are true and accurate to the best of my information and belief. This serves as my permission for the release of any information regarding this application for the purpose of credit investigation.
Dated 19
Signed
Title