Application

Please fill out and submit this form. We will respond within one business day.

Contact Information

Company Name*
Owner's Name*
Address*
City*
State*
Zip Code*
Phone*
Email*

 

Company Information

Entity Type
*In Business Since //

Customers you wish to factor

1. Company Name
Contact Name
Address
City
State
Zip Code
Phone
FAX
Account Open Since
Average Monthly Volume $
2. Company Name
Contact Name
Address
City
State
Zip Code
Phone
FAX
Account Open Since
Average Monthly Volume $

Referral Information

How did you hear about us?
Name of person that referred you

Terms & Conditions

The information supplied in this Confidential Financing Application, Company Profile form, and all forms and documents submitted (collectively the "Application") to Integrity Factoring & Consulting Inc., its subsidiaries or its Assignee (collectively "Funder") in connection herewith is true and correct to the best of my/our knowledge and belief. I/we hereby authorize Funder to investigate my/our financial responsibility and credit worthiness and will provide financial statements, tax returns, or other materials or information as requested by Funder and to verify any information provided from any source Funder may choose. I/we grant Funder the right to procure any and all credit or other investigative reports to any party to this application. I/we grant Funder the right to release any of the information contained herein or any results from any investigation of the information contained herein to any third party that may become part of any financing transaction between applicants and Funder or to whom Funder may refer this applicant to for funding. I/we further grant to any source from which Funder has requested information about applicant(s), the authorization to release such information to Funder. Applicant acknowledges that Funder will rely on the information provided herein to make its credit decision regarding Applicant. This Application has been completed and signed under penalty of perjury. A photocopy, including a fax copy, of this authorization may be accepted as an original.

I agree*

*Required Field