Factor Direct Capital

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2) Supplier / Reference Name:

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3) Supplier / Reference Name:

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Applicant(s) have been told and do understand that the submission of this application for financing does not commit 800LoanMart to provide any financial services.
Applicant(s) further have been told and understand that approval may come only after the management of 800LoanMart approves said application and the invoices and accounts offered are approved in accordance with the terms of 800LoanMart's Factoring Agreement.
Applicant(s) declare under penalty of perjury that the foregoing information is true and correct. Any failure of Applicant to truthfully disclose or accurately describe the information requested herein may result in a breach of any agreements between 800LoanMart and Applicant.
Applicant(s) authorize 800LoanMart and anyone acting on its behalf to verify and investigate any or all of the foregoing information, including, but not limited to Applicant's credit standing and financial responsibility. Applicant(s) grant 800LoanMart the right to procure any and all credit reports pertaining to Applicant or any of its Principals.

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