Invoice Factoring Application

This invoice factoring application will gather some information about you and your business. It generally takes about 5 minutes to complete. There are no fees and no obligations to apply.

Of course, any questions, at any time, simply contact us. We look forward to working with you!

* All fields are required
Unique ID
Personal Information
Name*
First Last
Email*
Phone*
Job title*
How did you hear about us?*
Affiliate ID*
Prior personal or business bankruptcy?*
Estimated Credit Score*
Social Security Number
Percentage of Ownership
Business Information
Legal Business Name*
DBA (if different)
Business Phone*
Business Address*
Business City*
Business State*
Business Zip Code*
Website*
Legal Entity Type*
State of Incorporation*
Business Start Date*
MM slash DD slash YYYY
Business Tax ID*
Are any federal or state taxes past due?*
Is the business in active bankruptcy?*
Is there any judgment or pending litigation against the company or any principal?*
What products and/or services do you offer?*
Who are your customers?*
Gross monthly revenues*
How long does it take for your customers to pay on average?*
What is your total outstanding Accounts Receivable balance?*
How soon do you need factoring?*
Do you currently have other financings?*
Lender's name*
Document Upload
Upload a copy of your current Accounts Receivable aging report*
Max. file size: 2 GB.
Upload a copy of your current Accounts Payable aging report*
Max. file size: 2 GB.
Upload a copy of the most recent monthly business bank statement*
Max. file size: 2 GB.
By submitting this application and entering your name below, you (i) authorize Number72 LLC (i95Capital.com) and its lending partners to use any credit bureau or business service to verify the information you provided; (ii) consent to receiving calls from Number72 LLC at the telephone number provided above, even if that number is listed on a state, federal, or corporate Do-Not-Call registry; (iii) acknowledge that you are not required to provide this consent as a condition of receiving any credit or services from Number72 LLC, and that you may apply for financing by contacting us directly; (iv) agree to Number72 LLC's Terms and Conditions; and (v) confirm that you have read Number72 LLC's Privacy Policy.
Applicant's Full Name*
Date*

Invoice Factoring Application

Personal Information

Business Information

Document Upload

Business Financing

CRE Financing

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