Contact Us

A/R Financing and Factoring Application

BUSINESS INFORMATION:
*Company Name:
*Address 1:
Address 2:
*City:
*State:
*Zip:
*Country:
*Phone:
Fax:
Website URL:
ADMINISTRATIVE CONTACT INFORMATION:
*Contact Name:
Title:
Telephone:
E-Mail Address:
INDUSTRY INFORMATION:
Industry: (eg. Telecommunications)
Type of entity:
Other Type of entity:
Legal status:
Years established:
Have you factored before?	Yes No
If so, with whom?
FINANCIAL INFORMATION:
Annual Sales
Open receivables:
Approx number of customers:
Average invoice size:
Any taxes past due?	Yes No
If so, description:
Any assets now assigned, pledged, or liened as collateral for loans?	Yes No
If so, description:
COMPANY DESCRIPTION: Please provide a brief description of your company, its services, and your factoring needs:

Financing Services

Member National Association
of Equipment Leasing Brokers

EMAX Financial Services
254 Garfield Avenue
Oakhurst, NJ 07755
Phone: 917-673-4371 • Fax: 928-396-5480