Factoring Application Form - Charter Capital - Factoring Made Simple

Today:

Online Application

Applying to factor at Charter Capital is a quick and easy process!!! Fill in our online application below and we will have an answer for you, usually on the same day. If you prefer to print out an application instead, click here and fax it back to us at (713) 960- 1821. (You will need the free Adobe® Reader® to download the application.)

For immediate attention, feel free to call us, toll free, at (877) 960- 1818 and ask for an account representative. Or click here to request more information.

Applicant Information

Tell Us About Yourself

Applicant (Legal Business Name)
Street address
City
State		Zip
County
Telephone
Cell phone
Fax
Email address
How did you hear about Charter Capital?

Business Information

Federal Tax ID #
Date business established
Legal form of business (pick one)
If your business is a sole proprietorship or partnership, list the legal names of the owners.
If your business is a Corporation or LLC, what is your Charter Number?
Describe your primary business activity
Does Applicant or any of its owners, partners or shareholders operate or have ownership in any other businesses or trade names?		yes no
If so, please list
Has Applicant or any owner ever filed bankruptcy?		yes no
If so, please give details
Have any liens or judgments been filed against Applicant or any owner?		yes no
If so, please describe
Is there any actual or proposed litigation relating to the Applicant or any owner?		yes no
If so, provide details
Is Applicant current on all Federal and State tax related payments and filings?		yes no
If not, please provide details
Have any of applicant’s owners, shareholders, or partners ever been convicted of a felony?		yes no
If so, please provide details

Ownership / Management

Name
Address
City
State
Zip
Phone number
Title
% Ownership
Date of Birth
Social Security No.

Name
Address
City
State
Zip
Phone number
Title
% Ownership
Date of Birth
Social Security No.

Name
Address
City
State
Zip
Phone number
Title
% Ownership
Date of Birth
Social Security No.

Name
Address
City
State
Zip
Phone number
Title
% Ownership
Date of Birth
Social Security No.

Accounts Receivable Information

1. What is your accounts receivable balance?
Approximately how much did you invoice in the past 30 days?
3. Approximately how much did you invoice in the past 12 months?
4. Do Applicant’s receivables serve as collateral for any purpose?	yes no
If so, with whom?
5. Approximately how many active customers do you have?
6. What is your average invoice size?
7. Is Applicant or any owner related to any customer account?	yes no
If yes, list names
8. Does Applicant sell any goods or services to customers from which Applicant purchases goods or services?	yes no
If yes, list names
9. Has applicant (or an owner of applicant) ever factored its receivables before?	yes no
If yes, with what factoring company?

Banking Information

1. Bank Name
2. City and State
3. Account number
4. Routing number
5. Does the Applicant have any outstanding Secured loans or leases?	yes no

Lender's Name	Contact Telephone	Balance	Description of Collateral

The undersigned understands that all information provided in connection with this form is for the purpose of aiding Charter Capital Holdings LP (Charter Capital) in its consideration of entering into a contractual relationship with the Applicant. The above responses are true and accurate to the best of my knowledge and belief, and Charter Capital may rely upon the same for all of its purposes. Furthermore, any party referenced in this form may rely upon this statement as authorization from Applicant to freely respond to any inquires made by Charter Capital regarding Applicant.

1. Applicant

2. Submitted by

3. Title

4. Please type your initials here
to sign this document

5. Date (mm/dd/yyyy)

Charter Capital services many industries. Here are just a few of the industries we are currently financing:

Trucking and Freight
It has never been easier for trucking companies and freight brokers to get cash with Freight Bill Factoring from Charter Capital. We purchase your freight bills and fund you within 24 hours, so you don't have to wait to get paid.

Staffing Firms
We can help you grow your staffing company with unlimited payroll funding , whether you're a start up or a multi-million dollar temp-staffing agency. Our clients provide staffing for various staffing industries including Professional, Office Services, Medical Staffing, and Manufacturing.

Security Firms
Demand for security services in the USA is on the rise. Be financially prepared to gain your share with a FactorLine facility only from Charter Capital.

Manufacturing
If your business is a manufacturing plant, distributor, packaging company, or any business that invoices to credit worthy customers, then a FactorLine from Charter Capital can accommodate the working capital funding needs of both new manufacturing companies as well as those that have been around for years.

Consulting & Service Firms
Service providers are great candidates for our FactorLine accounts receivable funding service, enabling you to increase your cash flow without the need for bank loans. We are always adding new industries and will consider factoring service providers in any industry.