ReceiveLink Business Questionnaire

Your Name *

First

Last

Business Legal Name

Business Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Industry *

Federal Tax ID *

Any Tax Liens? *

State of Business Registration *

Other States with Business Locations

Incorporation Type *

Year Business was Registered *

Number of Business Owners

Selected Value: 1

Please list all owner names and percentage of ownership *

Describe the Business, and Growth Projections (next 12 months) *

Are there any time frame issues we should be aware of? *

Please describe nature of time issues

Have you ever used Invoice Financing or Factoring before? *

Please Describe Experience, Include name of financing company *

Are you currently using Factoring for your Business? *

Name of Factoring Company *

When does your contract with the Factor expire? *

Has your business ever taken a loan? *

Please Provide loan information and details *

Current Balance owed to pay off loans

What is the Business' Average Monthly Revenue? *

What are your terms? (check all that apply) *

I don't offer terms to customers
Net 15
Net 30
Ned 45
Net 60
Net 90
Net 120
120 +

How many customers do you intend to Factor?

Selected Value: 1

Please provide the following information for the Top 5 Customers

- Customer Business Name - Average Invoice Size - Average Invoiced Monthly - Total Sales last 30 days - Total sales last 12 months

Customer 1 Information *

Customer 2 Information

Customer 3 Information

Customer 4 Information

Customer 5 Information

Please provide information about money owed to your business

Total Accounts Receivable Right Now *

A/R Aging (0-30) *

A/R Aging (31-60) *

A/R Aging (61-90) *

A/R Aging (91-120) *

A/R Aging (120 +) *

Please Select the Service you Wish to Discuss with your Business Advisor (Select all that apply) *

Factoring (Invoice Financing)
Purchase Order Financing
Loan Consolidation
Establish (Business) Credit

Thank you

Your Business Advisor will be in touch with you shortly.