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Accounts Receivable
Invoice
Factoring
   
ONLINE APPLICATION
Business name: *
Date Business Started:
Street Address: *
County:
City:*
State: *
Zip:*
Tel: *
Fax: *
Federal ID number:
Where did you hear about us:
If Other :
Type of Business:
Form of organization: *
Sole proprietor
Partnership
Corporation
LLC
State of formation:
Website:
Email:
Number of employees
PRINCIPALS
Name: *
Social Security #:
Title: *
%Own: *
DOB: *
DL #:
Home address: * Own: Rent:
City: *
State: *
Zip: *
Telephone #: *
Cell #:
Email:
Spouse's name:
SSN #:
RECEIVABLE INFORMATION
Amount of receivables now open:
Average monthly sales $:
Terms of sales:
Average invoice amount $:
Are you factoring now or have you factored before? Yes No
If yes, with whom:
Any other commercial loans/leases outstanding? Yes No --- Amount $:
The foregoing statements are true and accurate to the best of my/our knowledge. I/We hereby consent to the release of personal and business information and acknowledge that such information will be useful in qualifying me/us and the business for the requested financing. This authorization may be forwarded to third parties who are hereby authorized to release such information. I/We understand that submission of this application does not commit Winston Financial Group, Inc. to provide any financial services.
 

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