Home   About Us   Why Choose Us   Pricing   Apply Now   Contact Us 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.
	COMPANY INFORMATION Business Name Established Address City, State, Zip   Telephone Fax Cellular Type of Business Corporation,  Partnership or Individual ? If a corporation, what state of incorporation? If using a DBA, which county was the Assumed Business Name Statement filed? Place of Business If more than one place, state the place of the chief & executive office Previous business names used within the past five (5) years OWNER OR OFFICER INFORMATION Name/Title Address City, State, Zip Own or Rent Date of Birth Social Security # Drivers License #/ State Name/Title Address City, State, Zip Own or Rent Date of Birth Social Security # Drivers License #/ State Name/Title Address City, State, Zip Own or Rent Date of Birth Social Security # Drivers License #/ State ACCOUNTS RECEIVABLE INFORMATION Amount of Receivables Open Factored Before ? Source Fire Insurance Inventory $ Fix. & Equip $ Building $ Approximate No. of Accounts Terms of Sale Average Monthly Sales Volume $ Average Number of Monthly Invoices Average Invoice Amount $ Average Days A/R Turnover High Credit for Individual Account $ PERSONAL BANK INFORMATION Bank Name Address City, State, Zip Checking Account # Savings Account # BUSINESS BANK INFORMATION Bank Name Address City, State, Zip Account # TAX INFORMATION Federal, State, Local Taxes Past Due How Much $ Federal $ State $ Local $ Federal Tax Number Franchise Tax Number ADDITIONAL INFORMATION Principal Suppliers Are any assets now assigned, pledged, liened as collateral for loans? A/R To Whom Inventory Equipment To Whom Fixtures To Whom Other To Whom How did you hear about us ?