Consumer Receivables Financing Application

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Financing Application

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Consumer Receivables Financing Application

Please complete and submit this Application to receive
a free, no obligation Consumer Receivables Purchase Proposal.



Your Name

Company Name

Street Address

City	State	Zip


Phone #	Fax #

Best time to call	Email Address



Length of time in business	Number of locations



Description of product or service purchased by consumer


Length of time before product or service is fully delivered (include any promised support and/or guarantees)


How is your product or service sold to consumers
Yellow Page ads Direct sales Internet Phone
TV Infomercials Seminars

What is the profile of your customer


Do you currently offer a financing program? Yes No

If yes, do you currently sell these receivables? Yes No

Which lenders do you currently use?


Will we replace or work in conjunction with your current financing program? Replace Work With

What is the current monthly volume of financed sales?


What is the principal balance of your current receivables portfolio?


How much of that portfolio is delinquent (90 days or more past due)?


Do you check credit prior to extending financing? Yes No

Which credit reporting agency do you use? Experian Trans Union Equifax

Contract: Average amount financed?


Contract: Down payment amount?


Terms offered (6, 12, 24, 36, 48, or 60 months)?


Interest rate charged %?


What do you do with delinquent accounts or write offs?


Will you need retail installment contracts supplied? Yes No

Are company financial statements prepared? Yes No

How often are company financial statements prepared?


Have you or your company ever filed for bankruptcy? Yes No

If yes, please provide details


How is your personal credit?


Explain any problem areas with your personal credit


Are the principals of your company willing to personally guarantee receivable purchases? Yes No

Have you had any complaints filed against you with the Better Business Bureau or the Attorney General? Yes No

If yes, please explain.


Additional Comments or Information