Print this form and fax to: 303-972-4016

Prospective Customer Profile

Legal Business Name__________________________

Address____________________________City__________State_________ Zip__________

Phone___________________________Fax___________________Website/E-Mail___________________

Does the company         __Own   __Rent the property?  Other locations:________________

	Landlord's Name:__________________________________Landlord's Phone_____________
	
	Landlord's Address:__________________________________Montly Rent: $____________

Entity (choose one)   ___Corporation  ___Partnership  ___Sole Proprietorship

                              Date Started_________________

Type of Business:_____________________________________# Employees:__________
Employer ID #_________________________

Any past due taxes? ______________If yes, please explain________________________________

Has a lien been filed?_______________


Shareholders/Officers (if more than three, please attach separate page)

Name______________________________________Title__________________ Ownership %____________

  Home Address_______________________City___________State ______ Zip:_______ DOB:__________

  Phone:___________________ Social Security #________________ Driver's License #______________
								 State_________

Name______________________________________Title__________________ Ownership %____________

  Home Address_______________________City___________State ______ Zip:_______ DOB:__________

  Phone:___________________ Social Security #________________ Driver's License #______________
								 State_________
Name______________________________________Title__________________ Ownership %____________

  Home Address_______________________City___________State ______ Zip:_______ DOB:__________

  Phone:___________________ Social Security #________________ Driver's License #______________
								 State_________
Bank References (if more than one bank, please attach separate page):

Name of Bank_____________________________________ Contact Person____________________________

  Address____________________________________________ Phone_____________________________

  Account Number______________________________ Since: ____________ Loans?__________
								   Collateral?____________

Supplier/Vendor Trade References (if applicable)

Vendor__________________________ Contact Person____________________ Phone___________________

Vendor__________________________ Contact Person____________________ Phone___________________

Vendor__________________________ Contact Person____________________ Phone___________________

Receivables Information:

Monthly Revenues: $_________________  Anticipated Monthly Factoring Volume:____________________

Has the Company Factored Before?__________ When_____________________ With Whom_________________

Approximately Number of Invoices Per Month_____________ Any "Work in Progress" Billing?_________
If so, what % of total?___________________

Invoice Preparation Frequency (circle one):  Sporadic    Daily     Weekly      Monthly

Who prepares your invoicing?________________________________________________________

Do you require Purchase Orders from  your Clients?_________ What other documentation do you require?______________

What documentation is required by your clients to accompany your invoices?_________________________

Internal Accounting Software used:____________________________________

Do you require Credit Applications from your clients?___________________________

What information do you require?______________________________________________________

Support Information (if applicable)

Accountant:________________________________________ Contact:___________________________

  Address_______________________________ City______________ State_____ Zip_____________

  Phone_________________________________ Fax____________________ E-mail________________

Insurance Agent:___________________________________ Contact:___________________________

  Address_______________________________ City______________ State_____ Zip_____________

  Phone_________________________________ Fax____________________ E-mail________________

Attorney:_________________________________________ Contact:___________________________

  Address_______________________________ City______________ State_____ Zip_____________


Who referred you to NABFonline?________________________________________________________


I understand this is not an application for credit.  The intend of this profile is for
NABF to determine if a factoring program would be beneficial.  I authorize you to 
investigate the information supplied on this profile.


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Signature				Printed Name			Date



  Phone_________________________________ Fax____________________ E-mail________________