FACTORING APPLICATION FORM

Complete this form to find out if your company qualifies for Rexford Funding's factoring solutions!

Company Name:
Type of Business:
First Name:
Last Name:
Phone Number:
Phone Ext:
E-mail Address:

Avg Monthly Sales:
Amount You Want To Finance Monthly:
Current Outstanding Receivables:
Are Receivables Pledged To a Financial Institution:	yes no
If Yes, What is the Current Amount of the Outstanding Loan: