Online Application

You can complete the application online (below) or by
downloading, printing and faxing in our application.

BUSINESS INFORMATION
Company Name:
DBA:
Current Address Street:
City:
State:
Zip Code:
Telephone Number:
Fax Number:
Email Address:
Website URL:
Federal Tax ID Number:
State of Organization:
Type of Business:
PERSONAL INFORMATION
Name:
% Ownership:
Home Address Street:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:
SSN:
LIST OTHER OWNERS / PARTNERS
(if more than 2 owners / partners, provide additional documentation separately via fax or email)
Name:
% Ownership:
Home Address Street:
City:
State:
Zip:
Phone:
Fax:
Email Address:
SSN:
DOLLAR AMOUNTS OF COMMERCIAL A/R NOW OPEN
Also, please email (to info@magfinancial.com) or fax (864-573-9912) a current A/R aging with your application if available. If you are a start up business, please simply put $ 0 in the table below:
Total Outstanding $:
Current $:
30 Days Old $:
60 Days Old $:
90 Days Old $:
ADDITIONAL INFORMATION
Also, please email (to info@magfinancial.com) or fax (864-573-9912) a current A/R aging with your application if available. If you are a start up business, please simply put $ 0 in the table below:
Are any Accounts Receivables pledge as collateral?:
If Yes, to Whom?:
Are you currently factoring?:
If Yes, to Whom:
Do you process your own payroll?:
Have you ever filed for bankruptcy?:
(Magnolia can work with you if you've had a prior bankruptcy)
Are there any judgments pending by or against the company?:
(Magnolia can work with you if you've had/have liens or judgments)
Is there any pending or threatened litigation against the company?:
NAME OF 5 LARGEST ACCOUNTS TO BE FACTORED
Customer #1
Customer #1 Name:
Street Address:
City:
State:
Zip Code:
Web Address of Customer:
Average Monthly Sales for this Customer:
Average Time it takes to get paid (in days):
Credit Line Desire for this customer:
Customer #2
Customer #2 Name:
Street Address:
City:
State:
Zip Code:
Web Address of Customer:
Average Monthly Sales for this Customer:
Average Time it takes to get paid (in days):
Credit Line Desire for this customer:
Customer #3
Customer #3 Name:
Street Address:
City:
State:
Zip Code:
Web Address of Customer:
Average Monthly Sales for this Customer:
Average Time it takes to get paid (in days):
Credit Line Desire for this customer:
Customer #4
Customer #4 Name:
Street Address:
City:
State:
Zip Code:
Web Address of Customer:
Average Monthly Sales for this Customer:
Average Time it takes to get paid (in days):
Credit Line Desire for this customer:
Customer #5
Customer #5 Name:
Street Address:
City:
State:
Zip Code:
Web Address of Customer:
Average Monthly Sales for this Customer:
Average Time it takes to get paid (in days):
Credit Line Desire for this customer:
ABOUT MAGNOLIA
Where did you hear about Magnolia Financial, Inc.?

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Company:
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