Firmco Financial Full Application

Firmco Financial

Application

Firmco Financial Application

80+ Years of Experience

At Firmco Financial, we provide smart, accessible financing solutions to help your business acquire the equipment, vehicles, and tools it needs to thrive.

General Customer Information

Company Name

Phone #

Fax #

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business

Years in Business

# of Employees

Email Address

Federal ID No. (FEIN)

State of Organization

Company Type (Proprietorship, LLC, Corporation)

Owner/Principal Name

First

Last

Owner/Principal Name

First

Last

Phone #

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

% Owned

Social Security Number

Have you ever declared bankruptcy? If yes, when?

Bank & Insurance Information

Bank Name

Account #

Average Bank Balance

Insurance Company

Policy #

Contact Person

Phone # or Email Address

Current Business Operations

Do you currently have trucks, trailers, or additional equipment?

Tell us about current work contracts & arrangements including company name(s) and payment frequency

Signature

Clear Signature

Title

Date

Vendor Information

Information Business Balance

Name

Phone # or Email Address

Address

Address Line 1

Address Line 2

City

State

Zip Code

Contact

Equipment Description

Quantity, Type, Make, Model of Equipment

Disclaimer

I agree to the below text

The information in this Application provided by the Undersigned is true and correct in all respects and Firmco may rely upon the same for purposes of entering into an Accounts Receivable Financing Agreement with the Undersigned. Firmco is hereby authorized both now and in the future to (i) check the credit history of the Undersigned and the Undersigned’s business including bank accounts and personal credit reports and (ii) make available to Firmco’s corporate affiliates information relating to the Undersigned’s financial condition, including but not limited to reports prepared by credit agencies and information obtained from Undersigned’s creditors. Firmco is hereby authorized to file a UCC financing statement for the collateral contemplated fro this financing transaction. The undersigned warrants that He/She has authority to execute this Application and the Accounts Receivable Financing Agreement and to bind the Undersigned to the terms contained therein. The Undersigned authorizes all deposit and credit information to be released by telephone or fax. A photostat or facsimile copy of this authorization shall be valid as the original.