¡Welcome! You are just one step away from starting your application process. CONTACT INFORMATION CONTACT INFORMATION Name Position Email Phone Company name Company phone number Company Web Site Address City State / Department Postal Code FINANCIAL INFORMATION Expected financing amount: Last year sales: Last 12 month sales: Projected sales for next year: Total customers: Total employees: Name of top 3 customers: Taxes past due? NO YES Litigations, judgments or liens? NO YES Loans outstandings? NO YES BUSINESS ENTITY Business entity: Corporation LLC Partnership Sole Proprietorship FEIN FEIN: Date of foundation State of incorporation Additional locations Important: I certify that the information provided above is accurate and complete to the best of my knowledge. This information is presented to induce Bosa Investments to consider entering into a factoring agreement with this company. I/we hereby authorize Bosa Investments or its agents to verify and investigate any and all statements provided, including but not limited to assessing my/our creditworthiness and financial responsibility in any manner they deem appropriate. I/We: Grant Bosa Investments the right to obtain any and all credit reports relating to any of the parties listed on this application, including but not limited to all directors of the applicant company. SEND REQUEST