$ Nutech Capital Resources $
Receivables Application
First Name: Last Name:
Your Title:
Company Name:
Business Street Addrs:
City:
State:
Zip:
Country:
Phone:
Fax:
e-mail:
Business Structure:
State
No. of Owners/Partners:
Years in business? yrs
What Is the principal activity of this business?
Are your products or services being provided under:
Purchase Orders?  Contracts?  Invoices?
Average monthly sales volume: $
Who are your best customers?
When do they typically pay you? days
What is your Gross operating Profit Margin? %
Are there any liens against your company? yes no
Do you owe any back taxes? yes no
Do you have a line of credit with a bank? yes no
Have you factored in the past? yes no
If yes, with who and when?
Do you have ready access to: A receivables aging report? yes no
Customer list?yes no
Recent Tax Reports?
Federal?yes no
State? yes no
Personal?yes no
Questions, Requests, Comments:

When completed please click on the submit button below:

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Nutech Capital Resources | P. O. Box 305, Brownsville | California | 95919 | USA
Ph: 530-675-9151 | Fax: 530-675-9152 | e-mail: Richard@NutechCapital.com

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