APPLICATION FOR INVOICE FACTORING

Your First Name
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Your Last Name
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Your Email Address
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Best Number to Reach You
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Company Information

Company Name
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DBA - list any alternate trade name/s
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EIN
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Business Phone #
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Fax Number
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Street Address
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Mailing Address - If Different
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Website URL
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Years in Business
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Legal Business Status
  • - select one -
  • Corporation
  • LLC
  • Partnership
  • Sole Proprietor
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Industry, Type and Description of Business
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Number of Employees
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Past-Due Federal/State Taxes?
  • - select one -
  • No
  • Yes
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Tax Lien Filed?
  • - select one -
  • No
  • Yes
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Date/s and Amount/s of Taxes Past Due and/or Lien/s Filed
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Owners / Partners / Officers Information

Full Name
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Date of Birth
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SSN - Social Security Number
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Title
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Home Address
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Home Phone
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DL (Drivers License) #
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Mobile Number
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DL State
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% of Ownership
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Years with Company
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Email Address
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List any additional company owners / officers / partners below:
If there are no additional individuals to list, skip to next section.
 
Full Name
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Date of Birth
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SSN - Social Security Number
Field is required!
Title
Field is required!
Home Address
Field is required!
Field is required!
Home Phone
Field is required!
DL (Drivers License) #
Field is required!
Field is required!
Mobile Number
Field is required!
DL State
Field is required!
Field is required!
% of Ownership
Field is required!
Years with Company
Field is required!
Email Address
Field is required!
Full Name
Field is required!
Date of Birth
Field is required!
SSN - Social Security Number
Field is required!
Title
Field is required!
Home Address
Field is required!
Field is required!
Home Phone
Field is required!
DL (Drivers License) #
Field is required!
Field is required!
Mobile Number
Field is required!
DL State
Field is required!
Field is required!
% of Ownership
Field is required!
Years with Company
Field is required!
Email Address
Field is required!
Full Name
Field is required!
Date of Birth
Field is required!
SSN - Social Security Number
Field is required!
Title
Field is required!
Home Address
Field is required!
Field is required!
Home Phone
Field is required!
DL (Drivers License) #
Field is required!
Field is required!
Mobile Number
Field is required!
DL State
Field is required!
Field is required!
% of Ownership
Field is required!
Years with Company
Field is required!
Email Address
Field is required!

Banking and Financial Information

Open Commercial Loans

Open Commercial Loans with any other financial institutions (e.g., banks, credit unions, online lenders, installment lenders, merchant cash advance, factoring companies)? If yes, please provide lender names, loan amounts and a description of payment terms.
 
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Anticipated Monthly Factoring Volume in $

Total dollar amount you anticipate factoring every month:
 
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Have You Factored Before?

Have you factored invoices before under this business name or any other business name? If so, please list the business name(s) and factor name(s):
 
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Current Customer Payment Terms

For the invoices you anticipate factoring, describe the payment terms you extend to your customers:
 
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Use of Funds
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How Did You Hear About Corsa Finance?
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What is Most Important to You?
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Supporting Documents and Authorization

Please provide the following:
 
Copies of photo ID (front and back) for all owners/partners/officers
Upload copies of photo ID/s
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Copy of Voided Check from Company Bank Account
Upload copy of voided check
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3 Month's Bank Statements from Account Used for Business Transactions
Upload your documents...
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Business formation documentation (e.g., articles of incorporation, certificate of existence, certificate of good standing, etc.)
Upload Business Formation Docs
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Accounts Receivable Aging and/or Invoices from Debtor to be factored/copies of contracts or purchase orders
Upload Financial Docs
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AUTHORIZATION
By Submitting this Form:

By signature below, I/We acknowledge that application submission does not obligate Corsa Finance to purchase invoices from my company. I/We certify that all of the information provided on this application is true and correct to the best of my/our knowledge. I/We authorize Corsa Finance to make any credit, or investigative inquiry, or information verification that Corsa Finance determines appropriate for the extension of credit, or an invoice factoring program. I/We authorize Corsa Finance to file any applicable financing statements to perfect and maintain the security interests in accordance with the UCC.
 
Type Your Full Name
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Your Title
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Date of Submission
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Submit by an Alternate Method

If you prefer to submit your application (or supporting documents) by an alternate method, email to applications @ corsafinance.com or fax to 855-882-6777.

We'll begin processing the application and a Corsa Finance representative will contact you shortly.

APPLY ONLINE

Apply for online for non-recourse, full recourse or non-notification invoice factoring and get answers in 1-2 business days, or even faster:

  • Low reserves
  • Competitive rates as low as 5%
  • Great customer service
  • No minimums – factor only when you choose
  • Short term, long term and no-contract options
  • Fast turn-around and funding – we look for reasons to say “yes!”

If you prefer to submit your application (and/or some or all of the supporting documents) by an alternate method, email to applications @ corsafinance.com or fax to 855-882-6777.

We’ll begin processing the application right away and a Corsa Finance representative will contact you shortly.