Online Factoring Application

Ready to get started with invoice factoring? We invite you to use our confidential online factoring application and company profile.

The information will be sent electronically and our company will contact you shortly. We make every effort to respond by the next business day.

An application takes an average of 10 days to process assuming timely receipt of information and supporting documentation.  We promise to keep you informed every step of the way and you are welcome to contact us at anytime for updates.

Get Paid On Invoices Now!

Discover how factoring can turn invoices into cash… FAST!

  • Up to 95% Advance Rates
  • Factoring Fees as Low as 1.5%
  • Working Capital Without Debt
  • No Long Term Contracts
  • Strong Financials Not Required
  • 24 Hour Funding on Approved Invoices
  • You Control How Funds Are Used
  • Pay Bills, Fund Growth and Increase Profits!

Call Us at 574-315-3366!
»» Get Started Today! ««

Factoring Services Application

Company *

Your Name *


Your Email *

Business Phone Number *

CellPhone Number

Fax Number





Is Your Mailing Address the Same?

Years in Business

How Did You Hear About Us?

Accounts Receivable Information

Type of Business (Please describe your products or services.)

Sales Volume Monthly Sales Volume

Average Invoice Size $

Amount You Would Like To Factor Each Month

Have You Used Invoice Factoring Before?

If yes, please provide name of previous factoring company.

Balance of Oustanding Receivables

Receivable Balance Status (in days)

Average Number of Days to Collect

Write-off Percentage for Bad Debt (in %)

Business Information

Legal Name of Business

Trade Names or DBA (please list any used)

Legal Form of Business

State Where Business Was Organized

Year Business Was Organized

Federal Tax ID

DUNS Number (if any)

Ownership Information

Please provide legal name, home address, and percentage of ownership. The SSN may follow at a later time if you prefer.)

Please List and Describe Balances On Existing Financing

Please include any loans, lines of credit, or receivable financing now outstanding whether private or commercial.

Are all Federal and State taxes paid current (income tax, payroll tax, etc.)?

Are there any judgments, liens, bankruptcy filings, collections, felony convictions, or pending litigation against the company or owners?

Additional Documentation

Customer Information

Please provide information on the customers you would like to factor. This is for initial research and they will not be contacted at this time. You may also forward this information by email or fax transmittal.

Please upload an A/R aging report or forward via email or fax.

You may upload a file in xls, xlsx, txt, csv, or pdf format.

Additional Comments, Information, or Questions

Authorization and Acknowledgement

The foregoing information is provided by an authorized company representative for a commercial transaction and is true and correct to the best of my knowledge. Factoring Company or its agents are authorized to verify and investigate any or all of the foregoing statements including the right to procure credit information pertaining to all principals listed in this application. The undersigned understands the submission of this application does not mean a factoring transaction will be approved and additional documentation may be requested including an A/R aging report. A decision is usually reached within 10 days assuming timely receipt of information. A written proposal with terms will be provided by the Factoring Company for review and approval.

I have read the authorization and acknowledgment and would like to submit this form.*

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