Client Application
Business Information
Business Name
D/B/A Name(s)
Address
Address
City/State
Zip
Telephone Number
Fax Number
Website (if appl.)
E-mail Address
Form of Organization (check one) Corporation Partnership Other
Year Started
State of Formation
Tax ID #
Other Business Address 1
Address 2
Product or Type of Business
Have you factored before: If so, pleaseprovide name and number of factor
Has the company or any of its officers or principals ever declared bankruptcy before? If yes, please explain
Sales Information
Average Monthly Sales
% of Sales to be Factored
No. of Accounts
No. of Invoices Monthly
Average amount per Invoice
Sale Terms
Factoring Requirements
Amount Needed Monthly
Assets currently assigned, pledged, or liened
Accounts Recievable
To:
Inventory
To:
Equipement
To:
Other
To:
Bank and General Information
Bank Name
Account Number
Officer
Telephone Number
Address
Address
City/State
Zip
Accountant (Name and Phone)
Payroll Service (Name and Phone)
Taxes Current Yes No Amount
Any tax liens? Yes No Amount
Attorney (Name and Phone)
Owners, Officers, Partners
Principal #1
Full Legal Name
Title
Address
Address
City/State
Zip
Home Phone Number
Driver's License #
State
Birthdate
US Citizen? Yes No
Social Security Number
% Ownership
Marital Status
Have you ever been convicted of, arrested for, or charged with any crime?
Yes No If yes, please explain
Owners, Officers, Partners
Principal #2
Full Legal Name
Title
Address
Address
City/State
Zip
Home Phone Number
Driver's License #
State
Birthdate
US Citizen? Yes No
Social Security Number
% Ownership
Marital Status
Have you ever been convicted of, arrested for, or charged with any crime?
Yes No If yes, please explain
Owners, Officers, Partners
Principal #3
Full Legal Name
Title
Address
Address
City/State
Zip
Home Phone Number
Driver's License #
State
Birthdate
US Citizen? Yes No
Social Security Number
% Ownership
Marital Status
Have you ever been convicted of, arrested for, or charged with any crime?
Yes No If yes, please explain
Submit Form
The statements made and documents attached to this application are TRUE AND ACCURATE to the best of my/our knowledge and belief. I / We authorize Oxford Capital Partners, LLC to obtain whatever information regarding employment, bank accounts and/or outstanding credit that Oxford Capital Partners, LLC deems necessary in connection with this application or in the course or review or collection of any credit extended in reliance on this application. I/We authorize and instruct any consumer credit agency, commercial credit reporting agency, business, or person to compile and furnish to Oxford Capital Partners, LLC any such information regarding me / us or this business as may be requested by Oxford Capital Partners, LLC and agree that such information along with this application shall remain the property of Oxford Capital Partners, LLC whether or not this application is approved. The content of this application is acknowledged by the following owners / officers / principals.
By clicking submit below, I authorize Oxford Capital Partners, LLC to verify the information provided in the application, to obtain personal credit reports, file a financing statement, business reference reports and other information Oxford Capital Partners, LLC deems necessary.