Online Factoring Application, Instant Pre-approval, Quick approvals, Instant Cash

ONLINE APPLICATION* Required Field
* 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* Required Field
* Name:
Social Security #:
* Title:
* % Own:
* DOB:
DL #:
* Home Address:
* City:
* State:
* Zip:
* Telephone #:
Cell #:
Email:
Spouse's Name:
SSN #:
RECEIVABLE INFORMATION* Required Field
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.