| | |
| *Legal Name of Company | |
| *Primary Business Address | |
| *City | |
| *State | |
| *Zip Code | |
| *Business Phone | |
| *Fax | |
| Alternate Phone | |
| Email Address | |
| *Type of Company Corp.,LLC, etc., | |
| *Federal Tax I.D. No. | |
| *Date Business Started | |
| *Business Desc. (types of products or services) | |
| *Please identify Gov't Entity (Fed.,St.,Cty,City) | |
| *Are you still awaiting contract award? | |
| Current Contract # | |
| Date of Award | |
| End Date | |
| Contract Amount | |
| Fed. Gov't. Vendors:(Form#1449,DD250 or WAWF) | |
| Normal Terms of Sale | |
| Any Consignment Product? | |
| Avg. Discounts / Returns % | |
| # of active customers | |
| # of invoices per month | |
| Average Invoice Amount | |
| Gross Sales (Last Year) | |
| Projected Sales This Year | |
| Amount of Invoices You Intend To Factor | |
| *Have you ever factored before? | |
| *If yes, With whom? | |
| *Majority owners name | |
| *Home Address | |
| *.City | |
| *.State | |
| *.Zip Code | |
| S.S.# | |
| *Ownership % | |
| *Is your company required to be bonded? | |
| *Are all taxes current? | |
| If no,explain | |
| *Have any of the owners/officers filed bankruptcy? | |
| *Any Tax Liens,Judgments or Pending Lawsuits? | |
| *Are you a prime or sub contractor? | |
| *Do you subcontract out any of your work? | |
| *Does your company have any outstanding loans? | |
| If yes,to whom? | |
| If yes,for what purpose? | |
| What is the current balance of your loans? | |
| Please list who you may factor including address | |
| Comments | |
| | * Denotes a required field |