A/R Application

MoniCore International

A d v a n c e F u n d i n g R e s o u r c e s

Accounts Receivable /Application

INTRODUCTION

Welcome. We have created this on-line application to make your life easier and to expedite your funding request. The application gathers your

information, emails it to us and also produces a summary page for your file. If you have any questions you can call us at 888-718-0787.

Please complete each field in the application below. If the information is not applicable or unavailable simply insert "N/A" or "None". Please

review the information you entered, and if correct click the "Submit" button at the bottom of page. When you click the Submit button we

receive the information by email and can start processing your application. If any information needs to be revised please click your browser

back button to go back to page to correct or add information.

Print

Once you click the "Submit" button you will get a transmittal page. Please print out copies of this page for confirmation for your records.

(The single web page should print out as three printed pages.)

Thank you,

MoniCore International

(If you would prefer to not apply on-line you can print out a hardcopy by clicking here, Print application and fill it in and fax it to us

at 805-581-5913 or overnight mail to us.) MoniCore International, 1645 Deodora St., Simi Valley, CA 93065. If you have questions

call us at 1-888-718-0787

Section 1

1. Legal Name of Company (as shown on the ARTICLES of INCORPORATION or PARTNERSHIP AGREEMENT

Address
City	State Zip
Contact / Position
Phone
Fax
Email Address (Required)
2. Your business is a: Proprietorship Partnership Corporation Other
3. How long have you been in business?
4. Describe your business:


Section 2 Accounts Receivable Information
5. What is your average monthly billing?
6. How much of your average monthly billing do you wish to factor?
7. What is the average size of your invoices? Smallest? Largest?
8. Are any of your receivables progress billing? (In other words, do you bill in "as completed" phases for larger projects?) Yes No
9. List most important major customers: (Name / Address / Phone / Fax)







Section 3
10. Do you have any outstanding business loans? Yes No
11. Are receivables pledged as collateral? Yes No
12. Name of institution:
Loan amount & terms
13. Federal I.D. #
14. Do you have any current/pending tax problems? Yes No
Federal balance owed: State balance owed:
Any liens placed? Yes No Any levies placed? Yes No
Do you have a payment plan? Yes No Monthly Payment:
Name of IRS Agent: Phone:


Section 4 Bank Accounts
Bank/Branch/Phone
Address
Account #
Routing #


Section 5 General
15. Company's Attorney:
Phone:
Address:
16. Company's Accountant:
Phone:
Address:
17. Have you previously factored? Yes No
18. Name of previous factor: