Form

To apply for invoice factoring, please complete the secure form below. You will be asked to include a copy of all company owners’ driver’s licenses and Articles of Incorporation/Organization or DBA registration at the end of this form.

Company name*

Company Mailing Address*

City*

State/Region*

Postal Code*

Phone Number*

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Fax Number

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Mobile Phone Number

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Email*

Company Legal Status. Please check ONE option.*

C Corporation

S Corporation

Individual / Sole Proprietor

Limited Liability Company

LLC Type or Tax Classification

Only select from below if "Limited Liability Company" was selected from the above field.

Single Member LLC

C Corporation

S Corporation

Partnership

Registered State of LLC

Only enter state if "Limited Liability Company" was selected from the above field.

How did you hear about Sekady Capital?

Appraiser Credentialing Number

Only if applicable

Federal Tax ID*

Business Sector

Have you ever, or are you currently using another Factoring Company?*

What other Factoring Company have you used, or you currently use?

Only applicable if you answered "yes" to the question above.

When were you with another Factoring Company?

Enter "N/A" if no applicable.

Do you have a letter of release?

Only if applicable.

Please list all company owners.

Owner 1 Name*

Owner 1 Title*

Owner 1 Ownership %*

Owner 1 Email Address*

Owner 1 Social Security Number (Required for Owners)*

Please list all company owners.

Owner 2 Name

Owner 2 Title

Owner 2 Ownership %

Owner 2 Email Address

Owner 2 Social Security Number (Required for Owners)

Please list all company owners.

Owner 3 Name

Owner 3 Title

Owner 3 Ownership %

Owner 3 Email Address

Owner 3 Social Security Number (Required for Owners)

Application Authorization
I understand by executing this application I am indicating my intention to enter into a security agreement with Sekady Capital LLC (“Sekady”) but does not obligate Sekady to factor/finance or provide financial services whatsoever. The information and documents provided with this application are true and correct. This serves as my permission for the release of any information to Sekady for the purpose of credit investigation and that Sekady is authorized to verify, inquire of and confirm any information provided with this application. Sekady is authorized to execute financing statements in the name of the undersigned person and all application entities or affiliates. I also hereby authorize Sekady to contact our customers to verify the invoices submitted for factoring. Upon approval and the finalization of our financing statement, application agrees to reimburse Sekady $100 for the costs incurred by Sekady as a result of applicant’s withdrawal.

I understand and acknowledge the above statement.*

First Name*

Last Name*

Job Title*