Contract Factor – Credit Application

Legal Entity Name *

Email *

Website

Address *

Address Line 2

City *

State *

Postal Code

Legal Entity Type: *

Corporation

S-Corporation

Partnership

Proprietorship

LLC or LLP

Nonprofit Organization

State of Incorporation or Partnership *

FEIN# *

Date of Incorporation or Partnership *

Year Established *

NAICS Code (if known) and Principal Product or Service *

Is the Operating Company licensed in the USA *

Yes

No

If yes to the above, is your business certified? *

Yes

No

Type of Business Ownership *

If MBE, please state the Race/Ethnicity of Ownership Majority: *