Online Funding Application

Application To Enter Into Accounts Receivable Purchase Agreement

Please complete this online form. Additionally, please submit the following information via e-mail or fax to 201-944-9477: 1) most recent A/R and A/P aging reports (summary or detailed) 2) copy of Certificate of Incorporation 3) copy of principals driver’s license 4) copy of sample invoices 5) any additional information you would like to provide to assist Prestige Capital in evaluating your business for funding.

You can also DOWNLOAD our application and e-mail or fax it back to us at 201-944-9477. We’ll get you started ASAP.

PLEASE NOTE: Use the “tab” key to navigate from field to field. Use the “return” or “enter” button on your keyboard to continue onto the next step of the online application. Our application is four pages long and will take approximately 10-15 minutes to complete. In order to maintain confidentiality and security, the application will time out if left unattended. Please be sure to have all information pertaining to the Company’s Principals, Accountant, Attorney, Tax, Banking, and Accounts Receivable handy before you begin.

Page 1 of 4

Legal Business Name*

Phone No.*

All D/B/A, fictitious & assumed names

Address

Street Address City State ZIP Code

Does company own real property?

Yes

No

Date Established

Description of Business

Type of Business Entity

State in which company is incorporated

State

PRINCIPALS

Principal 1

Name (Principal 1)

First Last

Social Security No (Principal 1)

Date of Birth (Principal 1)

Home Address (Principal 1)

Street Address Address Line 2 City State ZIP Code

Home Type (Principal 1)

Own

Rent

Email Address (Principal 1)

Cell Phone # (Principal 1)

Home Phone # (Principal 1)

Business Title (Principal 1)

% Ownership (Principal 1)

United States Citizen (Principal 1)

Yes

No

Principal 2

Name (Principal 2)

First Last

Social Security No (Principal 2)

Date of Birth (Principal 2)

Home Address (Principal 2)

Street Address Address Line 2 City State ZIP Code

Home Type (Principal 2)

Own

Rent

Email Address (Principal 2)

Cell Phone # (Principal 2)

Home Phone # (Principal 2)

Business Title (Principal 2)

% Ownership (Principal 2)

United States Citizen (Principal 2)

Yes

No

Principal 3

Name (Principal 3)

First Last

Social Security No (Principal 3)

Date of Birth (Principal 3)

Home Address (Principal 3)

Street Address Address Line 2 City State ZIP Code

Home Type (Principal 3)

Own

Rent

Email Address (Principal 3)

Cell Phone # (Principal 3)

Home Phone # (Principal 3)

Business Title (Principal 3)

% Ownership (Principal 3)

US Citizen (Principal 3)

Yes

No

Page 2 of 4

SUPPORT INFORMATION

Name of Accountant

First Last

Accounting Firm Name

Accountant Phone No.

Attorney Name

First Last

Attorney Firm Name

Attorney Phone No.

TAX INFORMATION

Federal ID #

Number of Employees

Do you have Federal or State past taxes due?

Yes

No

If yes, has a lien been applied?

Yes

No

BANKING INFORMATION

BUSINESS CHECKING ACCOUNT

Name of Bank

Address

Street Address City State ZIP Code

Phone No.

Name of Bank Officer

First Last

Account Number

BUSINESS LOAN ACCOUNT

Name of Financial Institution

Address

Street Address City State ZIP Code

Phone Number

Loan Amount

Collateral

How long with the institution?

Page 3 of 4

RECEIVABLE INFORMATION

What is the intended use of the fund?

Dollar Amount of Receivables Currently Open

Date of Aging

Approximate number of customers

Terms of Sales

Average Monthly Sales

12 Month Sales

Do you sell goods on a consignment or right of return basis?

Yes

No

Do you buy products or services from any customers?

Yes

No

Do you employ any union workers?

Yes

No

Do you use a bonding company for any contracts?

Yes

No

List 4 largest customers, which you intend to factor. Please list exact corporate name and headquarter address:

Customer 1 Corporate Name

Customer 1 Phone No.

Customer 1 Address

Street Address City State ZIP Code

Customer 1 Maximum Credit Limit

Customer 2 Corporate Name

Customer 2 Phone No.

Customer 2 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Customer 2 Maximum Credit Limit

Customer 3 Corporate Name

Customer 3 Phone No.

Customer 3 Corporate Address

Street Address City State ZIP Code

Customer 3 Maximum Credit Limit

Customer 4 Corporate Name

Customer 4 Phone No.

Customer 4 Corporate Address

Street Address City State ZIP Code

Customer 4 Maximum Credit Limit

Page 4 of 4

OTHER

Amount you intend to fund on a monthly basis

Has your company funded receivables before?

Yes

No

Are your receivables currently pledged as collateral?

Yes

No

Is inventory currently pledged as collateral?

Yes

No

Any other secured Commercial Loans Outstanding?

Yes

No

How did you find out about Prestige Capital?

Name/Company Name

Phone No.

Enter Name and Title**

Email Address*

Please send completed Application with the following attachments:
1) Most recent A/R Aging, Summary or Detailed (aged preferably by Invoice Date, not Due Date)
2) Copy of an Open Invoice from AR Aging with supporting documentation (PO, Contract, Vendor Agreement)
3) Most recent A/P Aging Summary
4) Copy of Principal(s) Driver’s License(s)
5) Copy of Certificate and Articles of Incorporation.
6) Last 3 months Operating Bank Account Statements
7) Any additional information you would like to provide to assist Prestige Capital in evaluating transactions for funding
Please send additional attachments to:
Prestige Capital Corporation, fax no: 201-944-9477 or email to: tcallahan@prestigecapital.com

Application to enter into an Accounts Receivable Purchase Agreement

Application To Enter Into Accounts Receivable Purchase Agreement

Page 1 of 4

PRINCIPALS

Principal 1

Principal 2

Principal 3

Page 2 of 4

SUPPORT INFORMATION

TAX INFORMATION

BANKING INFORMATION

BUSINESS CHECKING ACCOUNT

BUSINESS LOAN ACCOUNT

Page 3 of 4

RECEIVABLE INFORMATION

Page 4 of 4

OTHER

PRESTIGE CAPITAL

QUICK LINKS

Prestige is a proud member of:

Prestige is a proud partner of: