Just fill out our easy form and you will be contacted by multiple factoring institutions to compete for your business. Why wait, don't delay. Please select the type of customer invoices will you be factoring?* Small businesses (1-100 employees) Medium-sized businesses (100 - 1,000 employees) Large businesses (1,000 employees or more) Government Non-profit organizations Approximately how much would you like to factor on a monthly basis?* $5,000 - 9,999 $10,000 - 29,999 $30,000 - 49,999 $50,000 - 99,999 $100,000 - 499,999 $500,000 - 999,999 $1,000,000+ Your approximate dollar amount of active or existing claims that creditors have on your accounts receivable?* $ What is the average invoice amount?* $0 - 99 $100 - 499 $500 - 999 $1,000 - 4,999 $5,000 - 9,999 $10,000 - 29,999 $30,000 - 99,999 $100,000+ What is the average amount of time needed to collect on these invoices?* 0 - 14 days 15 - 29 days 30 - 59 days 60 - 89 days 90 - 119 days 120 - 239 days 240+ days What type of product or service do you sell?* What was your company's annual revenues?* $0 - 99,999 $100,000 - 299,999 $300,000 - 499,999 $500,000 - 999,999 $1,000,000 - 4,999,999 $5,000,000 - 9,999,999 $10,000,000 - 19,999,999 $20,000,000+ When was your business started?* (example: 1994) Please describe in detail any additional requirements Contact Information Name* Company Name* Office Address* City* State* Zip Code* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New York New Hampshire New Jersey New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wyoming Wisconsin Washington D.C. Best Time To Contact* 6:00-8:00 A.M. 8:00-10:00 A.M. 10:00-12:00 P.M. 12:00-2:00 P.M. 2:00-4:00 P.M. 4:00-6:00 P.M. 6:00-8:00 P.M. Work Number* Cell Number - ext. - Fax Number Email Address* -
Please select the type of customer invoices will you be factoring?*
Small businesses (1-100 employees) Medium-sized businesses (100 - 1,000 employees) Large businesses (1,000 employees or more) Government Non-profit organizations
$5,000 - 9,999 $10,000 - 29,999 $30,000 - 49,999 $50,000 - 99,999 $100,000 - 499,999 $500,000 - 999,999 $1,000,000+
$
$0 - 99 $100 - 499 $500 - 999 $1,000 - 4,999 $5,000 - 9,999 $10,000 - 29,999 $30,000 - 99,999 $100,000+
0 - 14 days 15 - 29 days 30 - 59 days 60 - 89 days 90 - 119 days 120 - 239 days 240+ days
$0 - 99,999 $100,000 - 299,999 $300,000 - 499,999 $500,000 - 999,999 $1,000,000 - 4,999,999 $5,000,000 - 9,999,999 $10,000,000 - 19,999,999 $20,000,000+
(example: 1994)
Contact Information
Office Address*
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