J&D Financial Factoring and Purchase Order Financing Group

Construction Quick Application J&D Financial will only consider construction funding within the United States.
Owner Name:
Title:
Business Name:
Street Address:
City:
State / Zip:
Phone:
Ext:
Cell Phone:
Fax:
Email:
Web Site:
How did you find us?
If "Other" please describe:

What year did your company start?
What is your average monthly sales volume? $
Have you ever factored your receivables?	Sí No

If Sí, with whom:

Total Accounts Receivable: $
Receivables > 90 days from invoice date: $
Does the Company or its Owners have any judgements of liens filed against them?	Sí No
Does the Company or its Owners have any pending law suits against them?	Sí No
Do you have any outstanding loans?	Sí No

If Sí, with whom: Name of Financial Institution
Balance Owed: $

Do you have any UCC Filings:

Sí No

If Sí, with whom:

Are your receivables pledged as collateral:	Sí No
Are your other assets pledged as collateral?	Sí No
Have you or the company ever filed Bankruptcy?	Sí No
If Sí, when and provide an explanation:

Please list your current suppliers used and your general contractors on your current project.
Supplier #1 Name:
Contact:
Address:
City:
State / Zip:
Phone:
Amount Owed on Current Job:
Supplier #2 Name:
Contact:
Address:
City:
State / Zip:
Phone:
Amount Owed on Current Job:
Supplier #3 Name:
Contact:
Address:
City:
State / Zip:
Phone:
Amount Owed on Current Job:
General Contractor's Name:
Address:
City:
State / Zip:
Phone: