Accounts Receivable Factoring Application

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General Information

Ownership Information

Partner One:

Partner Two:

Partner Three

Background Information

Professional Services Information

Loans?

Yes No 

Accounts Receivable Information

Sales Generated Via (please check all that apply):

Purchase Order Contract Other 

Invoicing Method(s)

At Completion At Shipment At Delivery Progress 

Supporting Documentation

Copy of Articles of Incorporation and any amendment thereto:

Copy of the registered trade name, if applicable:

Copy of latest financial statements, interim and year-end

Detailed accounts receivable and payable aging reports

Customer list with complete addresses and fax numbers

Sample invoices (RE: 5 largest customers). Please include a copy of the invoice, proof of shipment, purchase order, vendor agreement(s) and other appropriate documentation.

Brochure or company literature

Transportation companies should also provide the following documents

Commercial Vehicle Operators Registration

Certificate of Insurance (Liability, Collision, Etc.)

US dot Registration (If Applicable)

Fwha /Interstate Operating Authority (If Applicable)

Copies of Registrations For Allowned or Leased power units and trailers (Cab Cards)

If inventory and/or equipment finance,or LETTERS OF CREDIT are being requested, please include the following information:

Business Plan and cash flow forecast

Detailed inventory list and summary, as applicable

Equipment list including name, model, date and price of purchase, as applicable

Details of secured lenders

Appraisal of assets, if available

Agreement

I / We hereby apply for the credit described in this application on behalf of the applicant business. I / We certify that I / we made no misrepresentation in this application or in any related documents, that all information is true and complete, and that I / we did not omit any important information. I / We agree that any property securing the credit will not be used for any illegal purpose. Money on Tap or its nominee (“MOT”) is authorized to verify with other parties and to make any investigation of my / our credit, either directly or through any agency / credit bureau. MOT may disclose to any other interested parties information as to MOT experience or transactions with my/our account. I / We understand that MOT will retain this application and any other credit information MOT receives, even if no credit is granted. These representations and authorizations extend not only to MOT, but also to any insurer of the credit and to any investor to whom MOT may sell all or part of the credit. I / We further authorize MOT to provide any such insurer or investor any information and documentation that they may request with respect to my / our application or credit.

Authorization signatures of each owner/applicant