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1
Business Info
2
Type of Business
3
Bank Info
4
Professional Services
5
Owner Info
6
Accounts Receivable
7
Authorization
Business Information
Business Name
*
Federal Tax ID
*
Date Established
*
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Nebraska
Nevada
New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
Website / URL
Must include "http://"
Phone
*
Fax
Next
Type of Business
Type of Entity
*
Sole Proprietor
LLC
C Corporation
S Corporation
Partnership
State of Organization
*
Type of Business | Primary Product/Service
*
Number of Employees
*
Number of Owners/Operators
*
Number of Company Trucks
*
Federal or State Taxes Past Due?
*
Yes
No
Which taxes are past due?
*
Federal
State
Both
Amount ($)
Has a tax lien been filed?
*
Yes
No
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Next
Bank Information
Bank/Financial Institution
*
Account #
*
Branch Location
*
Contact Name
*
Contact Email
*
Contact Phone
*
Contact Fax
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Next
Professional Services
Attorney Name
Attorney Company/Firm
Attorney Phone
Accountant Name
Accountant Company/Firm
Accountant Phone
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Next
Owner Information
How many owners in this company?
*
1
2
3
4
Owner #1 Full Legal Name
*
Owner #1 Position/Title
*
Owner #1 Social Security Number
*
Owner #1 Date of Birth
*
Owner #1 % of Ownership
*
Owner #1 Home Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Owner #1 Email
*
Owner #1 Phone (Cell/Primary)
*
Owner #1 Phone (Home/Other)
Owner #2 Full Legal Name
*
Owner #2 Position/Title
*
Owner #2 Social Security Number
*
Owner #2 Date of Birth
*
Owner #2 % of Ownership
*
Owner #2 Home Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Owner #2 Email
*
Owner #2 Phone (Cell/Primary)
*
Owner #2 Phone (Home/Other)
Owner #3 Full Legal Name
*
Owner #3 Position/Title
*
Owner #3 Social Security Number
*
Owner #3 Date of Birth
*
Owner #3 % of Ownership
*
Owner #3 Home Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Owner #3 Email
*
Owner #3 Phone (Cell/Primary)
*
Owner #3 Phone (Home/Other)
Owner #4 Full Legal Name
*
Owner #4 Position/Title
*
Owner #4 Social Security Number
*
Owner #4 Date of Birth
*
Owner #4 % of Ownership
*
Owner #4 Home Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Owner #4 Email
*
Owner #4 Phone (Cell/Primary)
*
Owner #4 Phone (Home/Other)
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Accounts Receivable
Average Monthly Sales
*
Accounts Receivable Balance
*
Average Invoice Amount
*
Average Number of Invoices per Month
*
How frequently are invoices generated?
*
Are invoices generated prior to receiving signed ticket?
*
Yes
No
Please explain.
*
Are any extended terms granted with the receivables?
*
Yes
No
Please explain.
*
Previous
Next
Authorization & Signature
I/we hereby solemnly declare and certify the information supplied in this Application is true and correct to the best of my/our knowledge and that the signer(s) hereto has/have full authority to provide the information. I/we hereby authorize TXP Capital, LLC (TXP) to procure and verify my/our credit worthiness and any other information provided or obtained by TXP in the course of its investigation, which in TXP’s sole discretion it deems appropriate, and to conduct independent background investigation(s) of this applicant(s) and the applicant’s business. I/we further provide authorization, on a continuing basis, for any person or business to release any and all credit reports or verifications to TXP.
Signature
Clear Signature
By signing, you agree to the terms above.
Date of Signature
*
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What Is Invoice Factoring?
Why Use A Factoring Company?
Invoice Factoring Calculator
Industries
Who Uses Factoring?
Oilfield & Gas Services
Trucking & Freight
Staffing Agencies
Financial Insights
Meet the Team
Contact
Apply Now
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