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 *

Number of Employees *

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 Invoice Financing for your Business? *

Name of Financing Company *

When does your contract 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 currently have?

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
Equipment Financing
Other Lending
Establish (Business) Credit
Loan Consolidation
Business Consulting
Business or Management Coaching
Sales or Management Consulting
Business Analysis
Efficiency Improvement

By submitting this questionnaire form to Atlas, I understand and am aware that the information I have provided may be used to qualify and search for partners within the Atlas Business Consulting network of partners in order to match their offers and services with the needs of my business. I further attest that everything provided in the attached questionnaire form is true and accurate to the best of my knowledge at the time of submission. I hereby grant my permission as an officer of my company to Atlas Business Consulting to act on my behalf in an effort to fulfill the requests I have made of them, and share any information with the members of their partnership network as may be required for that purpose and share the results with me so that I can make the best decisions for my company. I understand that all information contained in this questionnaire is considered confidential and only limitedly shared within the confines of the network group. Under no circumstances does the submittal of this questionnaire serve as a binding contract or obligate either me or my company in any way to do business with Atlas Business Consulting, its partners, or assigns. *

Acknowledged

Thank you

Your Business Advisor will be in touch with you shortly.