CLIENT PROFILEFull Legal Name of Business:E-mail:Other Names under which we do Business:Prior Business Names(s) used in Past 5 Yrs:Contact:E-Mail:Phone:Fax Number:Present Address:City:County:State:Zip:How long at above address:Name of :Phone Number:Corporation:Partnership:Individual:LLC:Other:Number of Employees:Years that business has operated:Date of:State of Incorporation:Federal Tax ID:Bank Name:Branch:Address:Phone:Briefly describe your business:Indicate if any of the following apply to the Applicant: (Check all those applicable)Bank credit line/loan:Liens:Lawsuits:Judgments:Back Taxes:SBA Loan:None of the applies:(if yes please provide details):Accounts Receivable Balances:1-30 days:31-60 days:61-90 days:Total:Average Monthly Sales:Terms of Sale:Avg. days receivables outstanding:Avg. Invoice size:Amount you intend to factor on a monthly basis:How will you benefit from factoring your accounts receivable?How soon do you need to start factoring?Have you ever factored your receivables?NoYesIf Yes, with whom?PLEASE PROVIDE A COPY OF YOUR MOST RECENT ACCOUNTS RECEIVABLE AGING REPORTPlease List up to 4 Customers You May Wish to Factor (Please note: Customers will not be contacted)Customer 1 Detail:Company Name: Contact Person Name: Phone Number: Email Address: Average Monthly Sales: Outstanding Balance: Company Address: City: State: Zip:Customer 2 Detail:Company Name: Contact Person Name: Phone Number: Email Address: Average Monthly Sales: Outstanding Balance: Company Address: City: State: Zip:Customer 3 Detail:Company Name: Contact Person Name: Phone Number: Email Address: Average Monthly Sales: Outstanding Balance: Company Address: City: State: Zip:Customer 4 Detail:Company Name: Contact Person Name: Phone Number: Email Address: Average Monthly Sales: Outstanding Balance: Company Address: City: State: Zip:I/We attest that all information provided to Marathon Financial (MF) is true and correct to the best of my/our knowledge, and is given to induce MF to consider entering into a factoring or lending relationship with the Applicant. I/we do hereby authorize MF or its agents to verify and investigate at any time the information provided including the obtaining of credit reports. A photocopy or facsimile of this authorization will be as valid as the original.
