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GREAT FACTORING RATES	Short-Form Below
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INTERNATIONAL (NON-U.S.) COMPANIES: Click Here to APPLY YOUR CONTACT INFORMATION Company Name Type of Ownership Corporation S Corporation LLC Partnership Sole Proprietorship Other How Long in Business? City and State Your Name Position With The Company Attorney CEO CFO Controller COO CPA Director Executive VP Office Manager Owner President Sr. Vice President Vice President Assistant Vice President Other Select Email Phone Type of Staffing (Perm or Temp Placement) Select Your Business Permanent Placement Temporary Placement Temp and Perm Placement Other

ABOUT YOUR ACCOUNTS RECEIVABLES Dollar Amount of Receivables Now Open Amount You Intend To Factor on Monthly Basis Are Your Accounts Receivables Pledged as Collateral? No Yes If YES, to whom?

Are You Factoring Now or Factored in the past? Yes No If Factoring Now If Factored in the Past
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