Application For Commission Advance

APPLICANT DETAILS

Applicant(s):

ABN

ACN

Business Address:

Postal:

Business Phone :		Mobile:

Business Fax:		Home Phone

Email Address:		Alt Phone

Type of Business/Employment:

Yrs Est.:	Years

No of Staff:

Date Incorp:

Bank:

Branch:

Contact:

Accountant:

Contact:

Address:

Ph:

Solicitor:

Contact:

Address:

Ph:

Individuals Full Name
(Directors, Applicants,
Spouse, Shareholders)

DOB

Home Address

Years At
address

Director
Y/N

Share
holding %

Previous
or other
names

Financial Requirements
Total Monthly Debts offered:
How will funds be used:
Any additional security offered:		Give details:

Customer (Debtor) Information
What is currently owed to you from your debtors	$
What percentage of your sales are provided on credit terms	%
What is the approximate number of debtors to be Factored each month
What is the approximate number of invoices to be factored each month
What terms do you normally provide to your debtors Days
What discount, if any, do you give for early payment	%
Do you have your debtors insured	Yes	No
Do you obtain purchase orders	Yes	No
Do you have signed proof of delivery	Yes	No
Do you sell on consignment/ sale return basis	Yes	No
Do you invoice on a progress claim basis	Yes	No
List any debtors who are also suppliers to your business:

Types of Debtors envisioned in the future (approx % of turnover to each)
Manufacturers/Wholesalers $	Retailers $	Importers $	Contractors $
Government $	Service Industry $	General Public $	Transport $

Customer (Debtor) Information
Has a manager/receiver or liquidator ever been appointed?	Yes	No	If Yes give details
Is there any unsatisfied judgement(s) entered in any court against the company or any of its officers?	Yes	No	If Yes give details
Has the company or any of its officers ever become or been bankrupt or insolvent or assigned its/their estate/s for the benefit of creditors?	Yes	No	If Yes give details
Has any application for factoring finance ever been submitted by the company or any of its officers to any other factoring organisation?	Yes	No	If Yes give details
Does any third party (Company or person) hold a mortgage or charge over the company or any of its assets?	Yes	No	If Yes give details
Is any legal action(s), pending?	Yes	No	If Yes give details
Have you ever been a Director of any company/business whatsoever during the last ten (10) years other than your current business?	Yes	No	If Yes give details

Details of 10 largest debtors
Debtor Name	ABN	Payment Terms	Credit Limit	Currently outstanding

Transport Only
Do you invoice your debtors	Yes	No
Are you paid using RTCI or Manifest If other please list:	Yes	No
Do you have a computer software accounts system (If so what type?: MYOB, Quick Books etc.)	Yes	No
Do you fuel out of Debtors	Yes	No
Is fuel showed separately on your invoice or docket	Yes	No

Construction Only
What proportion of your sales involve:
Retentions:	$	Invoices for work in progress	$

Additional Information:
To Assist Real Factor with considering your application further, we require the following information:
Brief profile on the business and directors listed in Section B	Yes	No
Aged debtors ledger (summary)	Yes	No
Aged creditors (summary)	Yes	No
Balance sheet and profit and loss for last two (2) financial years (Transport companies: one (1) only)	Yes	No
Cash Flow forecast for the next 12 months (if available)	Yes	No
NON TRANSPORT ONLY: PLEASE PROVIDE
Past two (2) Business activity statements (BAS) with proof of payment	Yes	No
Past three (3) months Bank Statements	Yes	No

Personal Statement of Position
Name:
Home Address:

Liabilities

$ Value

Assets

$ Value

Credit Cards

Bank:

Investments

Personal debts

Real Estate address:

$ pm

Vehicle & Plant:

$ pm

Other Loans From:

Other Loans to:

$ pm

Stock:

Other

Furniture & Personal Effects:

Superannuation:

Other Assests:

House details

Total Liabilities:

Total Assets:

Surplus:

Deficiency:

TOTAL

INSURANCE DETAILS	Insured	$ Benefit	Insurance Company
Life Cover $		$
Trauma Cover		$
Superannuation		$
Income Protection		$