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CapitalPlus Equity Online Factoring Application
Please complete the below factoring application. Once it is received you will be asked to submit additional documentation.
To assist CapitalPlus Equity, LLC (“CPE”) in its evaluation of whether to acquire Invoices issued by applicant (“Company”), we represent and warrant to you, the following information about the Company, its organizational structure, and other matters of interest to you.
Company Information
Legal Company Name *
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State of Incorporation *
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Years in Business *
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Primary Contact *
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Title
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Business Phone (direct)
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Business Phone (main)
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Cell Phone
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Fax
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Email *
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Business Address *
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City *
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State *
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Zip *
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Business Type *
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Federal ID *
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Describe Your Business *
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Has Company Ever Filed for Bankruptcy? *
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Are There any Judgments Pending Against the Company? *
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Is There Any Pending or Threatened Litigation Against the Company? *
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Federal or State Taxes Past Due? *
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If Yes, Amount?
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Year(s)
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Tax Lien Filed?
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Are Accounts Receivable Pledged as Collateral? *
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Is the Company Bonded? *
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How Did You Hear About Us?
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Would you be interested in receiving a free quote for professional back office services as well?
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If Yes, which services?
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Principals of Business - If there are more than two principals you will be asked to submit additional information once the application is received.
Principal
Name *
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Title *
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% Owned *
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Social Security # *
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Drivers License # *
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State *
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Place of Birth *
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Home Address *
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City, State, Zip *
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Home Phone
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Cell Phone *
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Email *
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Principal 2 (If applicable)
Name
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Title
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% Owned
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Social Security #
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Drivers License #
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State
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Place of Birth
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Home Address
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City, State, Zip
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Home Phone
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Cell Phone
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Email
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Additional Principals
We have additional principals *
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Additional information regarding the principal(s)
Have Any of the Principals of This Business Ever Filed for Bankruptcy? *
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Is There Litigation Pending Against the Principals? *
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Any Federal or State Taxes Past Due? *
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If Yes, Amount?
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Year(s)?
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3 Largest Accounts You Expect To Factor (Accounts are not contacted at this time.)
Third Largest Account
Owner
Name *
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Title *
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Date *
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In lieu of a signature please enter the last 4 digits of your social security number *
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Owner 2 (if applicable)
Name
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Title
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Date
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In lieu of a signature please enter the last 4 digits of your social security number
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Enter the numbers above * Enter the numbers above
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