Acct Receviables

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					                                                                                                                                                                            13750 San Pedro, San Antonio, TX 78232
                                                                                                                                                                             Phone: (866) 771-8433; (210) 490-7355
                                                                                                                                                                                               Fax: (210) 568-2114
                                                                                                                                                                                   Email: info@swcreditlender.com
                                                                                                                                                                                Website: www.swcreditlender.com

                                                                                                     Accounts Receivable Financing Application- All Industries
                                                              The following application contains three tabs located on the bottom of the spreadsheet. Please complete all information required
                                                                           and return via email in this Excel format--signed application to be returned via Adobe document or fax.
                                                      Business Information
                                                      Company Name: (If proprietorship, name the individual followed by assumed company or business name.)

                                                      Company Address:
                                                      City:                                       State:                                             Zip:                           County:
                                                      Business Structure: (Proprietorship, Partnership, Corporation, LLC)

                                                      Company's Subsidiaries and Affiliates:

                                                      Phone:                                         Fax:                                            Website:

                                                      D&B:                                                                                                      Fed. Tax ID:
                                                      Date Established:               Date inc.:                            State inc.:              Number of Permanent            Annual Sales:
                                                                                                                                                     Employees:
                                                      For Transportation Industry only:
IMPORTANT: Please fill out all information required




                                                      # of Tractors                   # of Trailers                         Total Owner Ops          Total Direct Drivers           Carrier Authority Yes or No


                                                      Paid for # Tractors             Paid for # of Trailers                Financed # tractors      Financed # Trailers            Broker of Cargo as well?

                                                      Business Description:



                                                      Does your company own real estate? (yes or no)                                                 Is the business space leased? (yes or no)
                                                      Contact:                        Phone:                                                         Email:
                                                      Owner's Information
                                                      Name:                                                                 Title:                                                  Ownership %
                                                      SS#:                                           Date of Birth:                                  DL#:                           State:
                                                      Home Address:
                                                      Home Phone:                                                           Cell Phone:                                             Married?

                                                      Email:
                                                      Spouse's
                                                      Name                                           Date of Birth:                                  SS#:
                                                      1. Family Reference:                                                                           Phone:
                                                      Address:
                                                      2. Family Reference:                                                                           Phone:
                                                      Address:
                                                      Name:                                                                 Title:                                                  Ownership %:
                                                      SS#:                                           Date of Birth:                                  DL#:                           State:
                                                      Home Address:
                                                      Home Phone:                                                   Cell Phone:                              Married?
                                                      Email:
                                                      Spouse's
                                                      Name:                                       Date of Birth:                        SS#:
                                                      1. Family Reference:                                                              Phone:
                                                      Address:
                                                      2. Family Reference:                                                              Phone:
                                                      Address:
                                                      Name:                                                         Title:                                   Ownership %:
                                                      SS#:                                        Date of Birth:                        DL#:                 State:
                                                      Home Address:
                                                      Home Phone:                                                   Cell Phone:                              Married?

                                                      Email:
IMPORTANT: Please fill out all information required




                                                      Spouse's                                    Date of Birth:                        SS#:
                                                      Name:
                                                      1. Family Reference:                                                              Phone:
                                                      Address:
                                                      2. Family Reference:                                                              Phone:
                                                      Address:
                                                      Banking Information
                                                      Bank Name:                                                                        Account:
                                                      Contact:                                                                          Phone:               Fax:
                                                      Bank Name:                                                                        Account:
                                                      Contact:                                                                          Phone:               Fax:
                                                      Insurance Carrier Information
                                                      Company Name:                                                                     Policy:
                                                      Contact:                                                      Phone:                                   Fax:

                                                      Bonding
                                                      Currently bonded?                           Bonding
                                                      (yes or no)                                 Company

                                                      Single Project Limit:                                                             Aggregate Limit:

                                                                           Have you ever been refused Bonding?
                                                                                  (yes or no) If Yes explain why?
                                                      Organization/Management

                                                                    Have you or your company ever filed for bankruptcy?
                                                                                  (yes or no) If Yes explain why?
                                                      Supplier Information
                                                                     Main Suppliers                           Product Supplied                     Contact            Phone Numbers




                                                                                                                         Page 2 of 14
                                                      Debt Schedule
                                                                                                                             Lease or          Original
                                                                    Lender                  Start Date        Due Date         Loan            Amount         Balance




                                                      Paid for Equipment
                                                                    Equipment Description                       Number of Units               Estimated Market Value




                                                      Real Estate Schedule
IMPORTANT: Please fill out all information required




                                                                                                                                       List Type:
                                                                                                          Estimated Market        Homestead, Residential,
                                                                Address of Real Estate Owned                    Value              Commercial, Industrial   1st Mortgage




                                                      Receivables
                                                      Current Outstanding Receivables' Total
                                                      Retainage Receivables' Total                                           Approximate Number of Customers:
                                                      Are receivables pledged as collateral?
                                                      Name of Bank or Factoring company
                                                      Pre-payment penalty clauses Factoring Group?


                                                                                                         LIST THREE (3) LARGEST CLIENTS

                                                               Company Name                                  Address                          Monthly Income Amount




                                                      Purpose and Amount
                                                                                     Working Capital:                                         Yes or No                 Amounts
                                                      Contract Receivables Financing-Progressive Billing
                                                      Accounts Receivable Financing -Final Billing
                                                      Structured Financing (Short and Long Term combined loans)
                                                      Equipment Financing
                                                                                                              Page 3 of 14
Financial and Administrative Mgmt of your Business (All Industries)
Other:


Authorization To Obtain Credit



By signing below, each undersigned individual who is either a principal of the finance / lease application listed below or a
personal guarantor of its obligations, provides written instruction to Lender or its Designee (and any Assignee or Potential
Assignee thereof) authorizing review of his/her credit profile considering the application of the credit application and
subsequently for the purpose of updating, renewal, or extension of such credit and for reviewing or collecting the resulting
account. A photocopy or facsimile of this authorization shall be valid as the original. In addition to authorizing review of
My/Our credit profile from any national credit bureau, the undersigned also authorizes My/Our financial institutions and
creditors to release credit information required by Lesser or its Designee (and any Assignee or Potential thereof).


Company Name:

Print Name:                                         Signature:                                    Date:

Print Name:                                         Signature:                                    Date:

Print Name:                                         Signature:                                    Date:

                                        PLEASE SIGN AND FAX A COPY FOR DOCUMENTATION


                               Please submit the following information with your application
Pre-Qualification and Presentation of Proposal:
1. Completed Application
   a)Debt Schedule (include Balance sheet arrangements, leases, rentals and etc.) in app
   b)Main Client's list with estimated sales volume per year-in application
2. Last three years Financial Statements (Income Statement and Balance Sheet-Accrual Basis).
3. Current Interim Financial Statement (Income Statement and Balance sheet- Accrual Basis).
4. Current Accounts Receivable Aging and Retained Aging (latter one when applicable)
5. Current Account Payables Aging
8.-Projected Financial Statements for the next two years




                                                         Page 4 of 14
an Antonio, TX 78232
8433; (210) 490-7355
  Fax: (210) 568-2114
@swcreditlender.com
 .swcreditlender.com


 mation required
 ax.




es:



 hority Yes or No


 argo as well?




                        Page 5 of 14
one Numbers




              Page 6 of 14
   Interest Rate




          Year




   2nd Mortgage




    Government
        or
    Commercial




Amounts




                   Page 7 of 14
 ed below or a
ee or Potential
ation and
g the resulting
  ing review of
 titutions and
reof).




      o
      o
      o
      o
      o
      o
      o
      o




                  Page 8 of 14
                                                                                         Main Client's List
Company Name


                                                 If applicable, indicate General Contractor or any other
                                                                                                           Government or
      Client's Name (Contract or Project Name)     intermediary between you and the end client (final                      Initiation Date
                                                                                                            Commercial
                                                                          client)
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                                                                       Page 9 of 14
Total

Note: We should get a list of all clients with addresses, contact name and phone.




                                                                             Page 10 of 14
               13750 San Pedro, San Antonio, TX 78232
                Phone: (866) 771-8433; (210) 490-7355
                                  Fax: (210) 568-2114
                      Email: info@swcreditlender.com
                   Website: www.swcreditlender.com




Completed and/or Estimated Yearly
                                    Profit Margin %
   Ongoing            Sales




                                                        Page 11 of 14
Page 12 of 14
                                                                                                                                      13750 San Pedro, San Antonio, TX 78232
                                                                                                                                       Phone: (866) 771-8433; (210) 490-7355
                                                                                                                                                         Fax: (210) 568-2114
                                                                                                                                             Email: info@swcreditlender.com
                                                                                                                                          Website: www.swcreditlender.com
                                                         Business Debt Schedule
                    Please make sure that collateral for each obligation is clearly identified in the collateral description column
Company Name                                                                                                    Date


                          Origination        Original          Monthly           Original       Remaining         Interest      Remaining       Collateral   Type of Account
      Lender Name                                                                                                                                            Loan, Lease Credit
                             Date            Amount            Payment            Term           Balance            Rate          Term         Description      Card, or etc.


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                                                                                    Page 13 of 14
INDICATE all business debt: Loan, Lease, Lines of Credit, etc.)




                                                                  Page 14 of 14

				
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