A/R Funding Form

M & M Funding Solutions

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APPLICATION


*Legal Name of Company
*Date Established
*Address
*City
*State
*Zip Code
*County
*Phone
*Fax
*Email
*Contact
*Title
State of Incorporation
Date of Incorporation
Federal Tax I.D. NO./ S.S. #
*Business Description
Outstanding Taxes - If Yes, Explain:
Existing Liens or Judgments - If Yes Explain:
Receivables Pledged as Collateral-If Yes, Explain:
*Company President
S.S.#
Company Vice Presidnnt
S.S.#
Corporate Secretary
S.S.#
Treasurer
S.S.#
*Name of company's bank
*Bank's Address
*Bank's phone no.
*Contact person at bank
Checking account number
Comments
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