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Operating
Funds LLC |
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P
O Box 113 |
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Altus,
Oklahoma 73522 |
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Phone:
580-477-1676 |
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Fax:
580-477-1828 |
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APPLICATION
FORM |
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| Name________________________________
Title ____________________ |
| Company
Name ________________________________________________ |
| Business
Address ______________________________________________ |
| City,
State & Zip ________________________________________________ |
| Phone
Number _____________Cell _______________ Fax_____________ |
| Nature
of Your Business _________________________________________ |
| Are
you a (circle one) Sole
Proprietor Partnership Corporation
LLC |
| FEIN
#________________________ How long in Business_____________ |
| Have
you ever factored before? ____ Other factors
name _____________ |
| Taxes
due/past due? None___ Local $______ State $______ Fed
$_______ |
| Litigation
/ judgments? Yes___ No___ If yes
please explain: __________ |
| ______________________________________________________________ |
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Estimate
the average monthly amount you want to factor $ ____________ |
| How
many invoice/month __________ Range in size/invoice $__________ |
Company Ownership:
Officers
Name |
Title |
Home
Address |
Soc
Sec # |
%
Ownership |
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Customers you wish
to factor:
Company
Name and Address |
Invoice
$ |
Credit
terms you gave |
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Business
references:
| Name |
Phone |
Company |
Your
Association |
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Banking
Information:
Name of Bank____________________________
Branch _________________
Contact person___________________________
Phone _________________
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foregoing information is true and correct to the best of my knowledge
and is given to induce Operating Funds LLC to consider entering into
a factoring agreement with this company. I hereby authorize Operating
Funds LLC or its agents to verify and investigate any or all of the
foregoing statements, including but not limited to my/our credit worthiness
and financial responsibility, in any way they may choose. I/We grant
Operating Funds LLC the right to procure any and all credit reports pertaining
to any party listed in this application, including, but not limited
to, all principals of the applicant company. |
Agreed
and consented to:
Signature____________________________
Print name__________________
Title_________________________________ Date_______________________
Copyright © Operating Funds LLC - 2005
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