Consumer Receivables

Accounts Receivable Factoring

Free Quote Application

Cell Tower Leases

Cell Tower Lease
Free Quote Form

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Consumer Receivables Free Quote Application

Please complete and submit this Application to receive
a free, no obligation Consumer Receivables Purchase Proposal.

Your Name
Company Name
Street Address
City State Zip

Phone # Fax #
Best time to call Email Address

Length of time in business Number of locations

Description of product or service purchased by consumer

Length of time before product or service is fully delivered
(include any promised support and/or guarantees)

How is your product or service sold to consumers
Yellow Page ads   Direct sales    Internet   Phone
TV   Infomercials   Seminars

What is the profile of your customer

Do you currently offer a financing program?  Yes   No
If yes, do you currently sell these receivables?  Yes   No
Which lenders do you currently use?
Will we replace or work in conjunction with your current financing program?
Replace   Work With

What is the current monthly volume of financed sales?
What is the principal balance of your current receivables portfolio?
How much of that portfolio is delinquent (90 days or more past due)?

Do you check credit prior to extending financing?  Yes   No
Which credit reporting agency do you use?  Experian   Trans Union   Equifax

Contract: Average amount financed?
Contract: Down payment amount?
Terms offered (6, 12, 24, 36, 48, or 60 months)?
Interest rate charged %?
What do you do with delinquent accounts or write offs?

Will you need retail installment contracts supplied?  Yes   No
Are company financial statements prepared?  Yes   No
How often are company financial statements prepared?

Have you or your company ever filed for bankruptcy?   Yes   No
If yes, please provide details
How is your personal credit?
Explain any problem areas with your personal credit

Are the principals of your company willing to personally guarantee receivable purchases?   Yes   No
Have you had any complaints filed against you with the Better Business Bureau or the Attorney General?   Yes   No
If yes, please explain.

Additional Comments or Information