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APPLICATION

Download Client Application in PDF Application to enter into a Security Agreement with Factoring Company

Business Information

Business Name*
Phone*
Street Address*
City*
Postal Code / Zip*
Email Address*
Type of Business*
Number of Employees
Company Legal Status*
Trade Names (DBA)*
Fax
Province / State
Country
Website Address
Website Address
Federal/State Taxes Past Due?

Principals

1. Name*
Driver's License*
Home Street Address*
Own Rent
City, State, Postal Code*
SSN
Date of Birth
Percentage of Company Ownership (%)
 
2. Name
Driver's License
Home Street Address
Own Rent
City, State, Postal Code
SSN
Date of Birth
Percentage of Company Ownership (%)
 
3. Name
Driver's License
Home Street Address
Own Rent
City, State, Postal Code
SSN
Date of Birth
Percentage of Company Ownership (%)

Support Documentation

The following will be needed with your completed application. You will be contacted for them.

  • Articles of Incorporation
  • Customer List
  • Accounts Receivable Aging or Invoices to Factor
  • Bank Authorization Form
  • Tax Authorization Form
  • Copy of Trucking Authority and Insurance (Trucking firms only)

Business Banking Information

Name of Bank*
Phone*
Fax*
Street Address*
City, State, Zip*
Account Number
Bank Contact*
 

Receivable Information

Dollar Amount of Receivables Now Open*
Average Monthly Sales*
Approximate Number of Customers*
Amount intended to factor on a monthly basis*
Maximum anticipated factoring volume*
How did you find out about TaxPRO Canada?
Have you ever Factored/Financed before?*
yes no
Are your receivables currently pledged as collateral?*
yes no
 

Principals Signatures

I/We further have been told and do understand that approval to factor may come only after an authorized person approves the application and the invoices/accounts offered are approved in accordance with the terms of Factor Security Agreement.

The above statements are true and accurate to the best of my knowledge and belief. By checking the box below and typing in my full name in the below space provided on this Rapid Line On-Line Application, this serves as my permission for the release of any information regarding this application to Factor for the purpose of credit investigation and I hereby consent to Factor collecting personal information including my personal credit report.

I further acknowledge that providing my SSN and other relevant account numbers on this form is optional for security and privacy concerns, but if I do not provide such information on this form that may delay the processing of the application and I will provide such information directly to the appropriate personal from Factor.

In lieu of a signature, please check this box:

And type in your full name in the box below:
 
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