Principal Owner Name*

First Last

Title

SSN*

Email*

Phone*

Legal Company Name*

Other Trade Names or DBAs

Company Address*

Street Address Address Line 2 City State ZIP Code

Business Type*

Monthly Factoring Volume*

MC#

US DOT#

# Power Units Owned

# Trailers

# Power Units Leased

# Leased Owner-Operators

Have you or has your company ever filed for bankruptcy?

Yes
No

Do you or does your company have any past due Federal or State Taxes?

Yes
No

Are there any UCC filings against you or against your company?

Yes
No

Are there any liens against you or against your company?

Yes
No

Have you or has your company ever used or currently using a factoring company?

Yes
No

Are you currently insured?

Yes
No

I/WE HAVE BEEN TOLD AND DO UNDERSTAND THAT THE SUBMISSION OF AN APPLICATION FOR FACTORING DOES NOT MEAN THAT COMPANY WILL FACTOR/FINANCE OR PROVIDE ANY FINANCIAL SERVICES WHATSOEVER. I/WE HAVE BEEN TOLD AND DO UNDERSTAND THAT APPROVAL TO FACTOR/FINANCE MAY COME ONLY AFTER THE APPLICATION AND THE INVOICES/ACCOUNTS OFFERED ARE APPROVED IN ACCORDANCE WITH THE TERMS OF SINGLE POINT CAPITAL’S CONTRACT. THE ABOVE STATEMENTS ARE TRUE AND ACCURATE TO THE BEST OF MY/OUR INFORMATION AND BELIEF. THIS SERVES AS MY/OUR PERMISSION FOR THE RELEASE OF ANY INFORMATION REGARDING THIS APPLICATION FOR THE PURPOSES OF CREDIT INVESTIGATION, GATHERING, REPORTING OR THE LIKE TO SINGLE POINT CAPITAL. ADDITIONALLY, PERMISSION IS HEREBY GRANTED TO FILE ALL UCC-1 FILINGS SINGLE POINT CAPITAL DEEMS NECESSARY.

I/We understand that Single Point Capital is only considering providing financing in a commercial transaction relationship and Applicant hereby states, warrants and agrees that any funds provided through this transaction will be used for commercial purposes only and not household, consumer or personal use.

I have read and agree to the above disclaimer*

Please check that you agree

How did you hear about us?*

If you heard about us through a referral, please specify below, if not just put N/A:*

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Single Point Capital - Factoring Application