Dear Client,

Please fully complete this application to the best of your ability. Answer all appropriate questions on this application even if it is a negative issue. You will want to let your new Funding Source know as much as possible. Our job is to help you get the cash you need. Any negative issues are not intended to disqualify you, but to allow us to confront these issues head on. So be accurate and truthful to the best of your knowledge. This is very important. You don't want to waste time, slow down your application, or not receive a quote at all!

Upon completion and submission of this form, you will receive an immediate email with your confirmation and funding source information. Please add “globalquickcapital.com” to your allowed email to ensure delivery.

Please note that these Applications are for conducting cash flow business or applying for loans only! These are not job applications!

Thank you,
GlobalQuick CAPITAL

Bankruptcy Factoring/Receivables Application

Requirements

Minimum: $10,000
No Maximum
Accepted Locations: Worldwide
Adults 18 and over only

Contact

•Contact First Name:

•Contact Last Name:

Title:

•Email Address:

•Phone Number:

Fax Number:

Cell Number:

Principals of Company

Principal 1 - Name:

Title:

Address:

Percent Ownership:

Principal 2 - Name:

Title:

Address:

Percent Ownership:

Principal 3 - Name:

Title:

Address:

Percent Ownership:

Principal 4 - Name:

Title:

Address:

Percent Ownership:

Bank References

Name of institution 1:

Address:

Bank Contact:

Bank Phone:

Name of institution 2:

Address:

Bank Contact:

Bank Phone:

Principal Customers

Please list the company's largest customers.
(Customers will not be initially contacted.)

Name of Company 1:

Address:

Monthly Sales:

Average Invoice:

Name of Company 2:

Address:

Monthly Sales:

Average Invoice:

Name of Company 3:

Address:

Monthly Sales:

Average Invoice:

Name of Company 4:

Address:

Monthly Sales:

Average Invoice:

Name of Company 5:

Address:

Monthly Sales:

Average Invoice:

Comments

Additional Comments:

•How did you hear about GlobalQuick CAPITAL?

Who Referred You?

No one referred me:

Referred Name:

Referred Phone:

Referred Email:

Application Id:

20241221-065710-592

Please note:

The Funding Source may require copy of additional documents
to make your quote. They will let you know by Email.

Upon submission of this form, you will receive an immediate email with your confirmation and funding source information. Please add “globalquickcapital.com” to your allowed email to ensure delivery.