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Please complete the following secure application for immediate consideration and we will contact you shortly. Remember that there are no fees whatsoever involved in the application process and please fill the application out where applicable.

Please note that if you are a Corporation we will need a copy of your Certificate of Incorporation or if you are a Sole Proprietor a copy of your DBA. Please fax us this information as soon as possible to 281-446-2269.

Applicant's acknowledgment: The completion of this application serves as my permission to K.W. RECEIVABLES for the release of any information regarding this application for the purpose of credit investigation. The below statements are true and accurate to the best of my knowledge.

   
 





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COMPANY INFORMATION
Business Name
DBA
Year Established
Address
City, State, Zip  
If more than one place, state the place of the chief executive office.
P.O. Box
City, State, Zip  
Telephone
Fax
Cellular
Email
Website
Type of Business
Corporation, Partnership, LLC, Sole Proprietorship or other?
State Registered in
County registered in
Federal tax ID number
Previous business names used within the past five (5) years
OWNER OR OFFICER INFORMATION
Name of owner or officer #1
% of ownership
Title
Home Address
City, State, Zip
Own or Rent
Telephone
Cell Phone
Date of Birth
Social Security #
Personal Email
Name of owner or officer #2
% of ownership
Title
Home Address
City, State, Zip
Own or Rent
Telephone
Cell Phone
Date of Birth
Social Security #
Personal Email
Name of owner or officer #3
% of ownership
Title
Home Address
City, State, Zip
Own or Rent
Telephone
Cell Phone
Date of Birth
Social Security #
Personal Email
ACCOUNTS RECEIVABLE INFORMATION
Are you currently factoring or have you factored before?
If yes, with whom?
Do you have a contract with the current factor?
If yes, what is the expiration date of the contract?
Do you process your own payroll?
Have you ever filed for personal or corporate bankruptcy?
If yes, what was the date you filed?
Any federal, state or local taxes Past due?
If yes, then how much?
Any Judgements or IRS liens against the company/ owners?
If yes, how much?
Any Pending or threatened litigation against the company/ owners
Total commercial accounts receivable open in $
0 - 30 days old
31 - 60 days old
61 - 90 days old
> 90 days old
** For pricing purposes please send us a current A/R aging report if available.

Names of the 4 largest accounts you would like to factor:
Customer # 1 Name
Customer # 1 Complete Address
Average Monthly Sales for this customer in $
Average speed of pay in days
Credit line requested for this client
Customer # 2 Name
Customer # 2 Complete Address
Average Monthly Sales for this customer in $
Average speed of pay in days
Credit line requested for this client
Customer # 3 Name
Customer # 3 Complete Address
Average Monthly Sales for this customer in $
Average speed of pay in days
Credit line requested for this client
Customer # 4 Name
Customer # 4 Complete Address
Average Monthly Sales for this customer in $
Average speed of pay in days
Credit line requested for this client
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