Money Solutions - Business Finance Application

Date (mm/dd/yy) Title
Legal Name

Phone
Operating Name Fax
Company Contact Cell
Address Email
City Prov & Postal Code


Describe your company and the business you do:

Sole Proprietor Partnership LLC Corporation
Corporation #:

Date established
Year in present ownership
Projected Annual Sales
Previous 12 months sales
Projected Net Income Previous 12 months net income
Average monthly accounts receivable
$ Approximate number of customers
Average invoice size $ Range of invoice size
Revenue Canada employer # Workers Compensation #

How often does your company remit payroll deductions?

Type of Tax

 Amount in arrears or “NIL”   Arrangements to repay
Payroll (source deductions) $  
Income $  
G.S.T./Federal $  
P.S.T./State $  
Workers Compensation $  
Other $  

Principals of the Company


Signing Authority Yes No Percentage Owned


   
Officer Name
SIN
Date of Birth
Home Address


Signing Authority Yes No Percentage Owned

   
Officer Name
SIN
Date of Birth
Home Address


Signing Authority Yes No Percentage Owned

Three (3) supplier references. (Companies who give you credit)

Name
Telephone
Business/Company
Association with you
Name
Telephone
Business/Company
Association with you
Name
Telephone
Business/Company
Association with you

Other information:


Banking Information

Name of Bank

 Branch
Chequing Account Contact person
Bank Routing # Telephone #

Are other company assets pledged as security? (check all that apply) Accounts Inventory Equipment

Bank Loans Collateral

Have you ever had any corporate or personal litigation or judgments? Yes No
If yes, please describe on a separate sheet.

Have you ever been convicted or found guilty of an offence under any law or are any charges now pending?
Yes No

If yes, please attach full particulars on a separate signed and dated statement.
Have you ever gone insolvent? Yes No

Professional References

Name of Lawyer
Telephone
Name of Accountant
Telephone

How did you hear about us:

The foregoing information is true and correct to the best of my knowledge and is given to induce Axess Group of Companies to consider entering into a factoring agreement with this company. I hereby authorize Axess Group of Companies or its agents to verify and investigate any or all of the foregoing statements, including but not limited to my/our credit worthiness and financial responsibility, in any way they may choose. I/We grant Axess Group of Companies the right to procure any and all credit reports pertaining to any party listed in this application, including, but not limited to, all principals of the applicant company.

AGREED AND CONSTENTED TO:

Enter your email address electronically sign and date this application
Print Name
Title
Date