Operating Agreement Certificates

							Application for Factoring Agreement
**All documents listed below need to be submitted with application**
DOCUMENTS REQUIRED:
    Completed Application
    Most recent Accounts Receivable Aging (in excel if available so that the sort function may be utilized)
    Most recent Accounts Payable Aging (in excel if available so that the sort function may be utilized)
    Prior year and most recent Profit & Loss, and Balance Sheet
    Past two years of filed tax returns
    Copy of most recent remittance of Payroll Taxes (Ex: copy of canceled check or Deposit Confirmation from EFTPS)
    Copy of an order from start to finish: a P.O., an invoice with backup (contract, timesheet, etc), & other documentation relevant to billing
    Customer list with contact names, address, phone number and credit limit for accounts to be factored
    Copy of previous 6 months bank statements (only need 1st page that shows # of deposits, etc)
    Articles of Incorporation or Articles of Organization
    By-Laws, Operating Agreement, or Partnership Agreement (which ever is applicable)
    DBA, Assumed Name, or Trade Name Certificates (if applicable)
    Personal Financial Statement
    Copy of business principal(s) driver’s license
    Copy of contract with existing factor, if applicable


GENERAL INFORMATION
Legal Name of
Business:                                                                                Trade Name (if any):
Office Address:                                                                          Mailing Address:

                                          City                  State        Zip                                                            City   State               Zip

Contact Information:
                                                   Phone                               Fax                                   Website                        E-mail

Company Structure:
                                          Select from Drop Down Box                Federal ID #                          Date Established            State of Incorporation

Bank Information:
                                                             Name                                             Account Officer                               Phone

Brief description of
business or primary
product:


5 largest customers            Customer Name                                 Monthly Sales                    Avg Invoice Amount                   Avg Days to Pay
you would like to
factor:




Please complete the information below:
Total Receivables:                  Current                 1-30 P/D    31-60 P/D            61+ P/D    Average # Invoices / Month

Total Billings:                             Last 30 Days                 Previous 12 Months             Average Invoice Amount ($)



   1) Have there been any changes in ownership in the past year?                                                   Yes                 No
     If yes, please explain on separate sheet.

   2) Has the company ever changed its name?                                                                       Yes                 No
     If yes, please explain on separate sheet.

   3) Are there any currently pending or threatened litigation or suits against the company or any of the
      company owners or guarantors?                                                   Yes                                              No
       If yes, please explain on separate sheet.




8f3a66bb-27d4-48c2-8d73-83bd14837a59.xls
OWNER/PRINCIPAL INFORMATION
Individual #1:
Full Legal Name:                                                         Ownership %:         DOB:
Title:                                                                   Home Phone:
Home Address:                                                            Cell Phone:
                                                                         E-mail:
                                  City              State         Zip
                                                                         SSN:

Individual #2:
Full Legal Name:                                                         Ownership %:         DOB:
Title:                                                                   Home Phone:
Home Address:                                                            Cell Phone:
                                                                         E-mail:
                                  City              State         Zip
                                                                         SSN:

Individual #3:
Full Legal Name:                                                         Ownership %:         DOB:
Title:                                                                   Home Phone:
Home Address:                                                            Cell Phone:
                                                                         E-mail:
                                  City              State         Zip
                                                                         SSN:

Individual #4:
Full Legal Name:                                                         Ownership %:         DOB:
Title:                                                                   Home Phone:
Home Address:                                                            Cell Phone:
                                                                         E-mail:
                                  City              State         Zip
                                                                         SSN:


HISTORICAL INFORMATION

1) Has this company ever sold, factored, or pledged its receivables?
          Yes      No     If yes, please provide the following:

                          Name of Lender:
                          Lender Address:

                                                                  City       State      Zip

                          Balance Owed:


2) Has any officer, owner, or director been associated with a company that has previously
   factored its receivables?
          Yes      No     If yes, please provide the following:


                          Name of Lender:
                          Lender Address:

                                                                  City       State      Zip

                          Balance Owed:


3) Have any of the principals or this company ever filed for bankruptcy?

          Yes        No



4) Are any Federal and/or State taxes past due?

          Yes       No    If yes, Balance Owed:




8f3a66bb-27d4-48c2-8d73-83bd14837a59.xls
BILLING PROCESS

    1) How does your customer order your products/services (Ex: PO)?




    2) At what point do you invoice?




    3) What do you receive as acceptance of your products/services (Ex: Signed BOL, Signed Timesheet, etc.)?




    4) Additional Notes:




   DO YOU HAVE:

      1. Progressive billings?                                                                             Yes          No
      2. Bill now but hold in inventory?                                                                   Yes          No
      3. Contracts with your customer?                                                                     Yes          No
      4. Contra accounts?                                                                                  Yes          No
      5. Sales to affiliates?                                                                              Yes          No
      6. Consignment sales?                                                                                Yes          No
      7. Customer deposits?                                                                                Yes          No
      8. Sales tax?                                                                                        Yes          No
      9. Billings prior to completion?                                                                     Yes          No
      10. Warranty of sales?                                                                               Yes          No
      11. Government sales?                                                                                Yes          No


    If you answered yes to any of the above questions, please explain:




The information supplied in this Application for Factoring submitted to Allied Affiliated Funding, L.P., is true and correct to the best of my knowledge.
I/We hereby authorize Allied Affiliated Funding, L.P., to investigate my/our credit worthiness and financial responsibility including obtaining information
such as copies of any and all financial &/or credit information relating to our company, which may be in actual or constructive possession of any
accountant, bookkeeper, bank, or any other person or entity. I/We authorize Allied Affiliated Funding, L.P., to conduct independent background
investigation(s) in considering this application. I/We grant Allied Affiliated Funding, L.P., the right to procure any and all credit reports pertaining to any
party to the Application for Factoring. EACH APPLICANT MUST SIGN AND DATE BELOW.

**Note: When form is complete, please save and e-mail to your Business Development Manager. Then print this page (Page 3 of
3), sign it, scan it, and email it along with the documents requested at the top of the page to your Business Development
Manager***


Signed By: _____________________________ Title:                                                           Date:

Signed By: _____________________________ Title:                                                           Date:

Signed By: _____________________________ Title:                                                           Date:

Signed By: _____________________________ Title:                                                           Date:




8f3a66bb-27d4-48c2-8d73-83bd14837a59.xls