MBS Financial Referral Income OpportunityFinancial InstrumentsVendor/Seller Programs
Purchase Order Funding Application

This form is also available as a download which can be faxed to 336-217-8155.
Word PDF RTF

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Purchase Order Funding Application
  Company:  
  Phone:  
  Fax:  
  Contact:  
  Title:  
  Address:  
  E-mail Address:
  Type of Business:  
  Years in Business:  

Purchase Order To Fund

 
  Customer Name:  
  Amount of Purchase Order:  
  Time Needed to Produce:  
  Delivery Date:  
  Funding Amount Needed:  
  Amount of Deposit received:  
  Describe Progress Payments Paid on Purchase Order:  
  Are We Required to Put Up a Letter of Credit?  
  Is Customer Paying With a Letter Of Credit?  
  Factor:  
  Sales Last Year:  
  Projected Sales This Year:  
  When is Funding Needed:  
  Current Lender and Details:  
  Current Tax Liabilities:  
  Broker:  
  Contact:  
  Phone:  
  Fax:  

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P.O. Box 1755 1 North Jefferson Ave.
West Jefferson, NC 28694
Phone: 336-219-0105
Fax: 336-217-8155

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