Application United Capital FundingQuick Application Save my progress and resume later | Resume a previously saved formResume LaterIn order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Business InformationNo cost to apply. Information submitted in this application is secure and confidential. For questions regarding this application, please call (877) 894-8232.This site is secure, all information submitted on this page is private.Business Information Name of Company (Full Legal Name) DBA Address City StatePlease select...ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Telephone Fax Email Address Website Federal Tax I.D. Number NAICS Code State Registered InPlease select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPuerto RicoVirgin IslandNorthern Mariana IslandsGuamAmerican SamoaPalau County Registered In Legal StructureCorporationPartnershipLLCSole ProprietorOther Type of Business/Industry Business Start DateOwnership InformationOwnership InformationPlease note that any additional owners with 20% or more ownership are required to complete a Credit Check and Release Form. A form will be provided after the application is submited. First Name Last Name % Ownership Title Home Address City StatePlease select...ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Telephone Cell Email Address Social Security Number Don’t worry, we only run a soft credit inquiry, which will not impact your credit score. Social security numbers are required to fully process the application, but we can gather this information through a Credit Check and Release Authorization form through email if you prefer not to submit it now. Are there other owners/partners?YesNoOwnership Information First Name Last Name % Ownership Title Home Address City StatePlease select...ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Telephone Cell Email Address Social Security Number Social security numbers are required to process the application. We can gather this over the phone later if you prefer not to submit it now.Accounts ReceivableDollar Amount of Commercial Accounts Receivable now open: Total Outstanding Current 30 Days Old 60 Days Old 90 Days Old Do you currently have a loan or line of credit for the business?YesNo If yes, to whom Are you currently factoring?YesNo If yes, to whom Do you have a contract?YesNo Expiration Date of the Contract Do you process your own payroll?YesNo Have you ever filed for personal/corporate bankruptcy?YesNo Any Federal or State taxes past due?YesNo Are there any judgments pending by or against the company?YesNo Any pending or threatened litigation against the company or any principal?YesNoAccounts to be FactoredAccounts to be Factored:Please supply the complete name, address, and credit limit. Use the "Add Another Account to Be Factored" link below the first account to add the next.Upload files Accounts Receivable (AR) Aging Accounts Payable (AP) Aging Customer List (with street addresses)Account Your Customer's Name Customer's Street Address (No PO Box) Customer's City Customer's StatePlease select...ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Customer's Zip Requested Credit Limit for This Customer Average Monthly Sales for This Customer Average Time it takes to get paid Current Outstanding Accounts ReceivablesSubmitted byUse the fields below to enter the information of the individual submitting the application Name Title Email Company Name How did you hear about us? (Factor Finders, Google, LinkedIn, or the name of your contact)By submitting this application, you authorize United Capital Funding to use any credit bureau or business to verify any information that is provided. United Capital Funding Group, LLC is a wholly owned subsidiary (WOS) of Gulf Coast Bank & Trust Company, New Orleans, Louisiana. Gulf Coast Bank & Trust Company is an FDIC-insured commercial bank. reCAPTCHA helps prevent automated form spam.The submit button will be disabled until you complete the CAPTCHA. Save my progress and resume later | Resume a previously saved formContact Information
