APPLICATION FOR INVOICE FACTORING

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

Company Information

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

Owners / Partners / Officers Information

Full Name
Date of Birth
SSN - Social Security Number
Title
Home Address
Home Phone
DL (Drivers License) #
Mobile Number
DL State
% of Ownership
Years with Company
Email Address

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

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.
 
Anticipated Monthly Factoring Volume in $

Total dollar amount you anticipate factoring every month:
 
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):
 
Current Customer Payment Terms

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

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
Copy of Voided Check from Company Bank Account
Upload copy of voided check
3 Month's Bank Statements from Account Used for Business Transactions
Upload your documents...
Business formation documentation (e.g., articles of incorporation, certificate of existence, certificate of good standing, etc.)
Upload Business Formation Docs
Accounts Receivable Aging and/or Invoices from Debtor to be factored/copies of contracts or purchase orders
Upload Financial Docs
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
Your Title
Date of Submission
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.