Apply Now Home Apply Now Share March 8, 2017by pac_admin Apply Now Home Apply Now Share Factoring Application Factoring Application If you are human, leave this field blank. General Information Business Name * Email Address * Address * Address Line 2 City * State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip * Length of time at current address Phone * Cell Fax Type of entity * Corporation LLC Sole Proprietor Federal Tax ID MC # Personal Reference for Business Name, Phone, Email How did your hear about PrimeArc Capital? Shareholder Information Note: Total ownership must sum to 100%. If more than two principals, please fill out free form field. Shareholder 1 Name Title % Owned Shareholder 2 Name Title % Owned Additional shareholders Operational Information Estimated Annual Sales ($) Amount to factor monthly ($) Has the company or any of the principals ever declared bankruptcy? Yes No Are there any unsatisfied judgments or liens against the company or its principals? Yes No Does the company have any outstanding loans or lines of credit? Yes No Are Federal, State and withholding taxes current? Yes No Are you doing business under any other name or do you own any other businesses? Yes No Do you have another business or has your business been listed under another name? Yes No reCAPTCHA Submit
