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Factoring Application
Services
Oilfield Factoring
Areas We Serve
Bakken Formation
Marcellus
Permian Basin
Rocky Mountains
Contact Us
Resources
News
Our Partners
Factoring Application
Application to Become a New Client
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Application to Become a New…
Business Information
Business Name
Business Type
Sole Proprietor
Partnership
LLC
Corporation
Business Contact Name
Business Phone Number
Business Email
Business Address
City
State
ZIP
Different Mailing Address
Mailing Address
City
State
ZIP
MC #
DOT #
How Many Employees (W2)
How Many Subs (1099)
Description of Your Business (What do you do)
Currently Factoring
Yes
No
Principal(s) of Business
First Name
Last Name
Title
% Ownership
Home Address
City
State
ZIP
Cell Number
Email Address
Social Security #
Additional Owners
Additional Owners
First Name
Last Name
Title
% Ownership
Home Address
City
State
ZIP
Cell Number
Email Address
Social Security #
First Name
Last Name
Title
% Ownership
Home Address
City
State
ZIP
Cell Number
Email Address
Social Security #
First Name
Last Name
Title
% Ownership
Home Address
City
State
ZIP
Cell Number
Email Address
Social Security #
Customers You Wish to Factor
Business Name
City
State
Phone Number
Monthly Average Volume ($)
Days to Pay
Worked With (Yrs.)
Additional Customers
Additional Customers
Business Name
City
State
Phone Number
Monthly Average Volume ($)
Days to Pay
Worked With (Yrs.)
Business Name
City
State
Phone Number
Monthly Average Volume ($)
Days to Pay
Worked With (Yrs.)
Business Name
City
State
Phone Number
Monthly Average Volume ($)
Days to Pay
Worked With (Yrs.)
Assets of the Company
How Many Trucks
How Many Trailers
Type of Trailers
Authorization
*
The forgoing information is true and correct to the best of my knowledge and is given to induce Integrity Factoring & Consulting, Inc. to consider entering into a factoring agreement with this company. I understand that by submitting this application it does not guarantee approval for financing or any other services that Integrity Factoring & Consulting, Inc. may provide. I hereby authorize Integrity Factoring & Consulting, Inc. or its agents to verify and investigate any or all of the foregoing statements and the right to procure any and all credit reports pertaining to any party listed in this application.
Who filled this out?
First Name
Last Name
Title
Date
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