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

International Account Receivables Factoring/Funding Application

Requirements

Minimum: Annual Sale volume $600,000
Maximum: Annual Sale volume $30,000,000
Accepted Locations: Worldwide
Adults 18 and over only

Contact

•Contact First Name:

•Contact Last Name:

Title:

•Email Address:

•Phone Number:

Fax Number:

Cell Number:

Company Information

•Legal Company Name:

DBA name (if applicable):

Present Company Address

•Address 1:

Address 2:

•City:

•County:

•State:

•ZIP Code:

•Business description:

Website:

Company Structure

•Structure:

Corporation
Partnership
Sole Proprietorship
LLC

Date Established:

State of Incorporation:

Date of Incorporation:

Number of employees:

Name of Attorney:

Attorney Phone Number:

Name of Accountant:

Accountant Phone 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:

Accounts Receivable Information

Domestic Receivables

Total Domestic Receivables:

$

Outstanding (0-30 days):

$

Outstanding (31-60 days):

$

Outstanding (61-90 days):

$

Outstanding (Over 90 days):

$

Export Receivables

Total Export Receivables:

$

Outstanding (0-30 days):

$

Outstanding (31-60 days):

$

Outstanding (61-90 days):

$

Outstanding (Over 90 days):

$

Sales

Average Monthly Sales - Domestic:

$

Average Monthly Sales - Export:

$

Financing

Amount of Financing Requested:

$

Average Number of Invoices per Month:

Average Invoice Value:

$

Customers

Total Number of Customers - Domestic:

Total Number of Customers - Export:

Average Number of Customers Sold per Month:

Average Number of Days to Collect:

Write-off Percentage:

%

•Receivables Generated From:

Goods
Sale of Services
Other

Terms of Sales:

Purpose of Loan/Use of Funds:

Background Information

Has the company ever factored or pledged its receivables as collateral?

Yes No

If yes, explain:

Are there any loans, private or commercial, now outstanding?

Yes No

If yes, explain:

Are there any receivables billed in currencies other than US Dollars?

Yes No

If yes, explain:

Are there distributors or agents used overseas?

Yes No

If yes, explain:

Are any extended terms granted in respect of receivables?

Yes No

If yes, explain:

Does the Company have a credit insurance policy in place covering domestic and/or export receivables?

Yes No

If yes, explain:

Are any Federal or State taxes, including Payroll Taxes, delinquent?

Yes No

If yes, explain:

Are there any Judgments or Liens now pending or in effect against the company?

Yes No

If yes, explain:

Has the Company or any of its Principals ever filed for Bankruptcy protection?

Yes No

If yes, explain:

Has any Owner, Officer, or Principal Manager of the Company ever been convicted of a felony?

Yes No

If yes, explain:

Do you use a payroll service such as ADP, Paychex or your bank?

Yes No

If yes, explain:

Does the company do business from more than one place?

Yes No

If yes, explain:

Has the Company ever operated under a different name?

Yes No

If yes, explain:

Domestic Customer Profile

Please list the company's largest or most active accounts you want to factor.
(Customers will not be initially contacted.)

Name of Company 1:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 2:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 3:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 4:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 5:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Export Customer Profile

Please list the company's largest or most active accounts you want to factor.
(Customers will not be initially contacted.)

Name of Company 6:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 7:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 8:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 9:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Name of Company 10:

Contact:

Phone:

FAX:

Address:

Account Number:

Monthly Volume:

$

Statement of Applicant's Assets and Liabilities (Short Form)

Assets

Cash in Bank(s):

$

Stocks/Bonds:

$

Accounts Receivable:

$

Notes Receivable:

$

Real Estate Owned:

$

Automobiles Owned:

$

Inventory (Raw Materials and Work in Process):

$

Other Assets:

$

Total Assets:

$

Liabilities

Unsecured Loans:

$

Secured Loans:

$

Accounts Payable:

$

Income Taxes Due:

$

Payroll Taxes Due:

$

Sales Taxes Due:

$

Mortgage Liability:

$

Inventory (Finished Goods):

$

Auto Loan/Lease:

$

Other Liabilities:

$

Total Liabilities:

$

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:

20241221-063429-416

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.

Privacy Policy & Security

Apply online for a free no obligation quote: Response in 24 to 48 hours in most cases. Our funding sources will be happy to answer all your questions at that time!

We are proud members of the cash flow/growing wealth industry.

We are a
green
company!

We at GlobalQuick CAPITAL believe in giving back to help in this world! A portion of the profits from our earnings will be given to: Heart Research, Arthritis Research, Endangered Animal Species, and Rain Forest Preservation.