business information
BUSINESS NAME Phone
ADDRESS fax number
CITY, STATE, ZIP date Established
PREVIOUS BUS. NAME county
no. of employees EMAIL ADDRESS
business type Corporation Partnership
Individual LLC
TYPE OF BUSINESS
owners or officers
name title
home address own or rent
soc. sec. # date of birth
d/l # home phone
name title
home address own or rent
soc. sec. # date of birth
d/l # home phone
name title
home address own or rent
soc. sec. # date of birth
d/l # home phone
bank account for business bank account for personal
name name
account # account #
branch branch
tax information
accountant name phone
financial. stmts frequency
federal ein franchise tax id
taxes past due agency
outstanding business loans
owed to amount collateral
owed to amount collateral
owed to amount collateral
have you ever factored before? yes
no
if yes, with whom?
accounts information
accounts receivable open avg. monthly sales
approx. # OF ACCOUNTS terms of sale
AVERAGE INVOICE AMOUNT high credit to ind.
customer accounts (Please list all customers)
company name address phone approx. monthly sales
terms of application
Please Type Your Name Here:
By clicking the checkbox next to the statement "I Accept" below, I hereby declare that the information provided in this application is true and correct to the best of my knowledge. I, without further notice, hereby authorize BRT Financial, Inc. and or our designees to make whatever inquiries deemed necessary concerning parties listed herein for the purpose of evaluating this application. BRT Financial, Inc.and or our designees is also authorized to provide any and all credit information relating to the parties herein to other creditors and/or credit reporting agencies. Applicant represents that applicant will use any and all monies borrowed primarily for the purpose other than personal, family or household usage. Applicant understands that submission of this application does not commit BRT Financial, Inc. and or our designees to provide any financial services.
I Accept, Please Submit My Application.

  


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