Factoring Application

Step 1 of 3

33%

APPLICANT
Your Industry
Complete Legal Name of Business*
Phone*
Business Address*
Street Address Address Line 2 City State ZIP Code
Trade Name
MC Number*
Website
Email*
# of Years in Business*
Federal Tax ID*
Type of Business*
- Sole Proprietorship
- Partnership
- Corporation
- LLC
# Of Years As Driver*
# Of Years Owner-Operator*
Operating Insurance Carrier*
EXISTING FLEET SIZE
# Trucks/Trailers Financed
# Trucks/Trailers Leased (Capitalized)*
# Trucks/Trailers Owned*
# Trucks Total*
# Trailers Financed*
# Trailers Leased (Capitalized)*
# Trailers Owned*
# Trailers Total*

GUARANTORS / PRINCIPALS
Name of Principal / Guarantor #1
First MI Last
First, MI, Last
Guarantor #1 Email
Guarantor #1 Date of Birth*
Guarantor #1 Social Security #*
Homeowner?
- Yes
- No
If Yes, How Long?
Guarantor #1 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name of Principal / Guarantor #2
First MI Last
First, MI, Last
Guarantor #2 Email
Guarantor #2 Date of Birth
Guarantor #2 Social Security #
Homeowner?
- Yes
- No
If Yes, How Long?
Guarantor #2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
ACCOUNTS RECEIVABLE INFORMATION
Accounts Receivable Total
Current
31-60
61+
Average Monthly Sales
# of Active Customers
Average Invoice Amount
Are You Currently Receiving Quick Pay from Brokers?
- Yes
- No
If yes, # of Active Quick Pay Customers
Have your receivables been financed or factored before?
- Yes
- No
If yes, explain
Are your receivables currently financed or factored?
- Yes
- No
If yes, with whom
Is the company now, or has it ever been in bankruptcy?
- Yes
- No
If yes, explain
Do you have any Federal or State taxes past due including, but not limited to, withholding taxes?
- Yes
- No
If yes, explain
Do you have any Contra Accounts (do you buy and sell to the same customer)?
- Yes
- No
If yes, explain
Do you have any Guaranteed Sales?
- Yes
- No
If yes, explain
Do you use a payroll service?
- Yes
- No
If yes, whom
Do you currently have a fuel card?
- Yes
- No
If no, are you interested in obtaining a fuel card?
- Yes
- No
Are you interested in Back Office Accounting Services?
- Yes
- No
Do you currently have Extended Warranty Coverage for your equipment?
- Yes
- No

DOCUMENTS REQUIRED
Driver's License Copy for all Owners and Officers
Drop files here or

Accepted file types: pdf, jpg, jpeg, gif, png.
Articles of Incorporation or LLC Operating Agreement
Accepted file types: pdf, doc, docx.
Current Aging of Accounts Receivable
Accepted file types: pdf, xls, doc.
Customer List with Addresses and Phone Numbers
Accepted file types: pdf, xls, doc.
Copy of the Company's Operating Insurance Certificate
Accepted file types: pdf, jpg, jpeg.
Copy of your Operating Authority
Accepted file types: pdf, doc, docx.
Copies of Invoices for Funding
Drop files here or

Accepted file types: pdf, doc, docx, xls.
Applicant understands that ENGS Commercial Capital intends to rely on the foregoing information in determining whether to enter into a factoring agreement, and applicant authorizes ENGS Commercial Capital to do so. Applicant also understands that the foregoing information may be incorporated by reference into an agreement between Applicant and ENGS Commercial Capital and any failure of Applicant to disclose truly, completely and correctly the information requested may constitute a breach of any such agreement. Applicant understand further that ENGS Commercial Capital has not, by requesting the completion of or accepting this application form, committed to make or implied intention or commitment to enter into a factoring program with Applicant. Applicant acknowledges that Applicant has retained a copy of this Application. Applicant hereby acknowledges consent to receive text and email messages sent by an automatic telephone dialing system. Consent to these terms is not a condition of funding. Message and data rates may apply. Applicant authorizes ENGS Commercial Capital (and any officer, employee, affiliate or other representative thereof) to obtain a consumer credit report through a credit reporting company chosen by ENGS Commercial Capital. Applicant hereby authorizes ENGS Commercial Capital (and any officer, employee, or other representative thereof) to visit and inspect any properties of Applicant; to discuss Applicant and its affairs, finances, and accounts with, and be advised as to the same by Applicant’s officers, employees, and independent public account; all to such reasonable extent as ENGS Commercial Capital seeks such information in good faith in connection with the within factoring application.

Applicant hereby authorizes ENGS Commercial Capital to immediately file a UCC financing statement covering all collateral of Applicant. The financing statement will become effective when (and if) Applicant and ENGS Commercial Capital enter into a factoring agreement. In the event Applicant and ENGS Commercial Capital fail to enter into a factoring agreement, ENGS Commercial Capital will file a termination statement. Applicant hereby authorizes its suppliers, customers, lenders, accountants, principals, officers, and attorneys to provide ENGS Commercial Capital (and any officer, employee, or representative thereof) such information about Applicant and its affairs, finances, and accounts as ENGS Commercial Capital may request. Applicant also authorizes each such person and firm to accept a copy of this Authorization as if it were an original.
Guarantor #1 Full Name*
Electronic Signature Agreement - Guarantor #1*
- I Accept
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. You further agree that your use of a key pad, mouse or other device to type your name constitutes your signature as if actually signed by you in writing.
Guarantor #2 Full Name
By filling in your full name above and entering a digital signature below you indicate you have read and agree to the above APPLICATION TERMS.
Electronic Signature Agreement - Guarantor #2
- I Accept
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. You further agree that your use of a key pad, mouse or other device to type your name constitutes your signature as if actually signed by you in writing.