AR Financing & Factoring Application Step 1 of 7 - Company & Ownership Information 14% indicates a required fieldLegal Name of Company*(as shown on the Articles of Incorporation or Partnership Agreement)Legal Form Under Which Business Operates*CorporationLLCPartnershipProprietorshipOthersFederal Tax ID*State of Incorporation*StateAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonIn Business Since*201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Number of Employees*Address*City*State*StateAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonZIP*Please describe your business & the owner(s) background* indicates a required fieldPartner/Owner #1Name*US Citizen?YesNoDOB Date Format: MM slash DD slash YYYY SSNPartner/Owner #2NameUS Citizen?YesNoDOB Date Format: MM slash DD slash YYYY SSNBilling InformationAverage Monthly Billing*Desired Factoring Amount*Average Invoice Size*Largest Invoice*Smallest Invoice*Do you bill in Progress stages?*YesNoAre any of your sales Bill and Hold?*YesNo indicates a required fieldLIST YOUR 3 LARGEST CUSTOMERS. YOUR CUSTOMERS WILL NOT BE CONTACTED AT THIS TIME.Customer #1Company Name*NameAddressCityStateStateAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonZIPPhoneEmail Payment Terms Current BalanceCustomer #2Company Name*Contact NameAddressCityStateStateAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonZIPPhoneEmail Payment Terms Current BalanceCustomer #3Company Name*Contact NameAddressCityStateStateAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingYukonZIPPhoneEmail Payment Terms Current Balance indicates a required fieldFinancial lnformationDo you have any outstanding loans and/or advances?*YesNoIs your inventory/receivables pledged as collateral?YesNoName of Financial InstitutionLoan Amount and TermsAre your Federal, State, and payroll taxes current?*YesNoFederal Taxes Owed?State Taxes Owed?Have any liens been placed?YesNoAre you on a payment plan?YesNoMonthly Payment?Legal lnformationIs the company, or any officer, involved in any type of litigation or lawsuit?YesNoPlease DescribeCompany AttorneyAttorney PhoneCompany AccountantAccountant PhoneHave you previously factored?YesNoWhat Factoring Company? indicates a required fieldFirst Name*Last Name*Title*Office Phone*Office Cell*Email* Email 2 How did you hear about us?How did you hear about us?BingBrokerEmail NewsletterFacebookGoogleLinkedInPostcard MailerReferralTrade-showYahoo Maximum file size is 2MB for each file. Accepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf. 3 Months Bank StatementsAccepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf.Accounts Payable AgingAccepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf.Articles of Incorporation & Operating AgreementAccepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf.Customer Contracts and/or Purchase OrdersAccepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf.Invoice AgingAccepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf.Sample Invoice with backup documentatione.g. proof of delivery, inspection, time sheets, or performance proofAccepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf. Attestation* I attest that the statements in this application are true and correct to the best of my knowledge. I authorize Paragon Financial Group, Inc. and its assignees to verify any or all of these statements in any way it may choose and has the right to procure all credit reports of the principles of the applicant company. Please enter your name as it appears on the information to sign this application*CAPTCHANameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.