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contract-purchase-order-accts-rec-SHEET
Discount Mortgage Submission Sheet

REQUEST FOR FINANCING: PURCHASE ORDER, CONTRACT, OR ACCOUNT RECEIVABLE

CLIENT INFORMATION

COMPANY NAME *

PHONE *

ADDRESS *

CITY *

STATE/PROVIDENCE *

ZIP CODE *

PRINCIPAL OFFICIAL CONTACT *

TITLE *

TYPE OF BUSINESS: * MANUFACTURINGWHOLESALERRETAILERIMPORTEREXPORTERCONTRACTOROTHER

PRIMARY CUSTOMER INFORMATION

COMPANY NAME *

PHONE *

ADDRESS *

CITY *

STATE/PROVIDENCE *

ZIP CODE *

PRINCIPAL OFFICIAL CONTACT *

TITLE *

PURPOSE OF FINANCING

PURCHASING OF FROM (LOCATION) MANUFACTURING FOR (DETAILED BUDGET OF COST ENCLOSED) IMPORTING/EXPORTING OF FROM/TO (LOCATION) *

PURCHASE ORDER & CONTRACT FINANCING

(COPY (S) OF PO(S) OR CONTRACT(S) ENCLOSED)

FORM OF FINANCING CASHLETTER OF CREDITDOCUMENTOTHER

NEEDED BY *

AMOUNT OF PO(S) OR CONTRACT(S)$ *

COST TO FULFILL (AMOUNT BEING FINANCED)$ *

DATE OF CONTRACT INCEPTION *

DATE PROJECT IS TO BEGIN *

PROJECT DATE OF COMPLETION *

PROJECTED DATE OF MDSE SHIPPED TO YOU *

VIA *

PROJECTED SHIPMENT DATE OF COMPLETION *

TRANSIT TIME -DELIVERY TO YOU *

TRANSIT TIME TO-WAREHOUSE *

CUSTOMER(S) *

URGENT DEADLINES *

SPECIAL SITUATION? *

PROPOSED PAYMENT DATE *

METHOD OF REPAYMENT *

NAME OF FACTOR (IF SET UP) *

ACCOUNTS RECEIVABLE FINANCING

(ENCLOSE COPY OF RECEIVABLE AGING)

AMOUNT OF ACCOUNTS RECEIVABLE $ *

ADVANCE REQUIRED (AMOUNT TO BE ADVANCED) $ *

TOTAL RECEIVABLES OPEN $ *

AVERAGE AMOUNT BILLED MONTHLY $ *

BILLING TIME EXTENDED CUSTOMERS *

AVERAGE INVOICE AMOUNT $ *

TYPE OF GOOD SOLD *

AVERAGE GOOD SHELF LIFE *

PERCENT ACCOUNTS RECEIVABLE: * 1-29 DAYS %30-45 DAYS %45-60 DAYS %60-90 DAYS %90-120 DAYS %120+ DAYS %

ADDITIONAL DOCUMENTATION REQUIRED

-BRIEF SUMMARY ON COMPANY-DESCRIPTION OF PROCEDURES-INCEPTION->DELIVERY->PAYMENT-MANUFACTURERS DETAILED COST BUDGET-BUSINESS CREDIT APPLICATION-COPY(S) OF PO(S), CONTRACT(S) OR RECEIVABLE AGING-COPY FINANCIAL STATEMENT & P&L

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