Application

Step 1 of 4

Business Information

Office: (915) 249-2477 | Email: cs@althonfactoringservices.com

In order to expedite the approval process, please fill out the application completely. After initial approval is given, additional information may be required prior to funding.

We will respond to your request within 48 hours.

Business Name

Business Address

Street Address

Street Address Line 2

City

State

ZIP Code

Business Start Date

Federal Tax ID Number (EIN)

Cell Phone

Fax

Email Address

Web Address

Legal Status

CorpLLCPartnershipSole Proprietor

Description of Business

Number of Employees

Taxes Past Due?

YesNo

Step 2 of 4

Officers, Owners, or Partners

Please list the principal owners, officers, or partners. If there are more than two, list any additional owners in the Notes box at the bottom of this page.

Owner / Officer / Partner #1

Name & Title

% Owned

Driver's License #

Date of Birth

Social Security Number

Email Address

Home Address

Street Address

City

State

ZIP Code

Owner / Officer / Partner #2 (if applicable)

Name & Title

% Owned

Driver's License #

Date of Birth

Social Security Number

Email Address

Home Address

Street Address

City

State

ZIP Code

Additional Owners / Notes

Notes

Step 3 of 4

Bank Information

Name of Bank

Date Account Opened

Bank Address

Street Address

Street Address Line 2

City

State

ZIP Code

Bank Contact

Bank Officer

Checking Account Number(s)

Loan Account Number

Outstanding Loan?

YesNo

Step 4 of 4

Documents & Signature

Supporting Documents

Please upload the following documents. Accepted formats: PDF, JPG, PNG, HEIC, TIFF, DOC or DOCX, up to 2 MB per file. A clear phone photo is fine.

Driver's License (each owner)

Articles of Incorporation / Organization

Certificate of Liability Insurance

Signature & Authorization

The above statements are true and correct to the best of my knowledge and belief. This serves as my permission for the release of any information to Althon Factoring Services regarding this application for the purpose of credit investigation. I hereby authorize Althon Factoring Services to investigate the credit of all parties listed above. I also hereby authorize Althon Factoring Services to contact our customers to verify the invoices submitted for factoring.

If you are approved, we will ask you for more information to expedite the process.

Printed Name

Title

Signature

Application

Althon Factoring Application

Business Information

Officers, Owners, or Partners

Owner / Officer / Partner #1

Owner / Officer / Partner #2 (if applicable)

Additional Owners / Notes

Bank Information

Documents & Signature

Supporting Documents

Signature & Authorization

Thank you! Your application has been submitted.