Full Business Name:
Business Address, City, State, Zip Code
Business Phone number:(xxx-xxx-xxxx)
Federal Tax ID#
State Tax ID#
Email Address
Select the service you are in need of
Professional Contacts: Accountant Firm(Name,Address,Phone)
Professional Contact: Banker Firm (Name,Address,Phone)
Professional Contact: Attorney Firm (Name,Address,Phone)
Professional Contact: Checking/Savings Account #s
Trade References: Business Suppliers(1)(Name,Phone,Contact,Service/Product Provided)
Trade References: Business Suppliers(2)(Name,Phone,Contact,Service/Product Provided)
Trade References: Business Suppliers(3)(Name,Phone,Contact,Service/Product Provided)
Attach any relevant information document(s)
Has Business ever been subject to a repossession or order of Replevin?
Yes No
Has Business ever declared bankrupcy?
Yes No
Is Business or its principals Defendant(s) in any legal actions?
Yes No
Are any Liens currently placed against Applicate's Accounts Receivable?
Yes No
Does Business have any outstanding loans?
Yes No
If YES, please provide: Name of Financial Institution: (Name,Adress,Phone Number,Loan Amount,Collaterial Pledged)
Has Business previously factored?
Yes No
If YES, please provide (Name,Address,Phone Number) of previous factor
ATTACHMENT CHECKLIST
Fluehr Craft National Network must conduct due-diligence to verify firm's legal standing and personal identity. Please email and include the following documents to ensure a speedy response:
Copy of company's Certificate of Incorporation
Copy of Articles of Incorporation
Corporate Tax ID#
Balance Sheet and Income Statement
Last available CPA Balance Sheet and Income Statement
Current A/R aging report
Current A/P aging report
Last 2 Corporate Tax Returns
Evidence of most recent tax payment for 941-QFTR and 1120-ITR (eg. copy of check or bank receipt)
Any relevant press releases, press coverage, product literuture that might help Fluehr Craft familiaize itself with products and or services offered.



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