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YOUR CONTACT INFORMATION
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Company Name
Type of Ownership
How Long in Business?
Country
City and State/Province
Your Name
Position With The Company
Email
Phone
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Type of Business (Industry)
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ABOUT YOUR ACCOUNTS RECEIVABLES
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Dollar Amount of Receivables Now Open
Amount You Intend To Factor Monthly?
Are Your Accounts Receivables Pledged as Collateral? No Yes If YES, to whom?
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Are You Factoring Now or Factored in the past?

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If Factoring Now - With Whom?

If Factored in the Past - With Whom?

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