Wilshire International Funding Group, Inc. 3600 Wilshire Blvd. Suite 708 Los Angeles, CA 90010 Tel : 213-368-0055 Fax : 213-368-0333 http :// www.wilshirefunding.com E-mail : Info@wilshirefunding.com ************************************************************************ CLIENT APPLICATION Business Information Legal Name of Company _________________________________________________ Business Address _________________________________________________ Suite _________________________________________________ City _________________________________________________ State _________________________________________________ Zipcode _________________________________________________ Telephone Number _________________________________________________ Fax Number _________________________________________________ Corporation ___ Corporation ___ Sole Proprietor___ State of Incorporation _________________________________________________ Year Started ___________________ D/B/A Name (if applicable)______________________________________________ Type of Business ______________________________________________ Federal Tax ID# ______________________________________________ State Tax ID# ______________________________________________ Business Credit References Name City & State Account # Phone Number ___________________ ______________________ ______________ ______________ ______________________ ___________________ ______________________ ______________ ______________ ______________________ ___________________ ______________________ ______________ ______________ ______________________ ___________________ ______________________ ______________ ______________ ______________________ Bank Information Name of Bank __________________________________________________________ Account Number __________________________________________________________ Address __________________________________________________________ __________________________________________________________ Contact __________________________________________________________ Phone Number __________________________________________________________ Name of Bank __________________________________________________________ Account Number __________________________________________________________ Address __________________________________________________________ __________________________________________________________ Contact __________________________________________________________ Phone Number __________________________________________________________ Check all items for which your bank has a security interest: Accounts Receivable__ Equipment__ Inventory__ Fixtures__ Any assets pledged as security please provide the following information: Name ______________________________________________________ Address ______________________________________________________ ______________________________________________________ Phone Number ______________________________________________________ Purpose & Security ______________________________________________________ Any Past Due Taxes? Yes ___ No ___ If so, what taxes? ______________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Has your company ever declared bankruptcy? Yes___ No___ If yes, what year? __________ Any Liens or judgements outstanding? If yes, explain. _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Sales Information Open Receivables ____________ Selling Terms ____________ Average Monthly Sales ____________ Projected Sales ____________ % of Sales to be Factored____________ Average Invoice Size____________ List largest customers and average monthly Receivables Customer Average Monthly Receivables ____________________________________________ ___________________________ ____________________________________________ ___________________________ ____________________________________________ ___________________________ ____________________________________________ ___________________________ ____________________________________________ ___________________________ ____________________________________________ ___________________________ ____________________________________________ ___________________________ Company Officers Name ______________________________________________________ Office Held ______________________________________________________ Address ______________________________________________________ ______________________________________________________ Phone Number ______________________________________________________ Social Security # ______________________________________________________ % of Ownership ______________________________________________________ Name ______________________________________________________ Office Held ______________________________________________________ Address ______________________________________________________ ______________________________________________________ Phone Number ______________________________________________________ Social Security # ______________________________________________________ % of Ownership ______________________________________________________ Name ______________________________________________________ Office Held ______________________________________________________ Address ______________________________________________________ ______________________________________________________ Phone Number ______________________________________________________ Social Security # ______________________________________________________ % of Ownership ______________________________________________________ Enclosures - Very Important 1. Current and prior year company financial statements 2. Articles of incorporation or D/B/A filing 3. Current accounts receivable aging 4. Blank invoice Declaration The above information and the enclosures are submitted are true and correct to the best of my knowledge and belief. I understand that Wilshire International Funding Group, Inc. will rely on this information and I hereby authorize any personal or business credit investigation deemed necessary by Wilshire International Funding Group, Inc. for the purpose of evaluating our credit and the credit of our clients. Signature __________________________________________________________ Date __________________________________________________________ Printed Name __________________________________________________________ Title __________________________________________________________