Sierra Capital, Inc. - Application Form

I Business Information

1. Business Name:

Tax ID Number:

2. Address:

3. Telephone:

Fax:

4. E-Mail:

Date of Incorporation:

5. Type of Entity (check one) :

CORPORATION PARTNERSHIP LIMITED LIABLITY CORP

6. How were you referred to Sierra Capital?

II Business History

1. Date Founded:

Number of Employees:

2. What type of products/ services does the business provide?:

3. List the individuals that hold major positions or have at least 10% ownership in the business.

President Name:

Home Address:

Telephone:

SS#:

Ownership%

Other Officers Name:

Home Address:

Telephone:

SS#:

Ownership%

Other Officers Name:

Home Address:

Telephone:

SS#:

Ownership%

III Bank and Credit Information

Primary Bank:

Address:

Telephone:

Officer's Name:

List all outstanding loans:

Lender(s):

Current Balance:

Telephone:

List two major suppliers:

Supplier:

Current Balance:

Telephone:

Supplier:

Current Balanace:

Telephone:

IV Receivable Information

1. What is the purpose of the funds to be generated from factoring/ financing?

2. Amount of receivables outstanding:

Terms of sales

3. Average monthly sales: $

Number of active accounts:

4. Average age of A/R when paid

Percent of uncollectable accounts:

5. Have you ever factored receivables:

YES NO

6 Are you currently factoring?

YES NO

7 Do your receivables currently serve as collateral?

YES NO

If yes, with whom:

V Tax Information

1. Federal or state taxes past due?

YES NO

2 Judgments, lawsuits or liens filed against the company or you ?

YES NO

3 Have you or the company filed for bankruptcy?

YES NO

If yes to any of these questions, please explain:

VI Getting Started

Fill out this application and submit it with the following supporting documents:

Current account receivable aging (showing pay history, if available)

Customer list showing complete names and address ( if not listed on aging)

Current financial statements ( last year-end and most recent interm)

VII Prior to Funding

Prior to the initial funding, Sierra Capital will require the following documentation:

Articles of Incorporation, Certificate of Limited Partnership, and/or Assumed Name Certificate

Quarterly 941 tax deposits receipts for the last year

Most recent tax return 1120 &1040

Personal Financial statement of principal(s)

Copy of invoices to be factored along with supporting documentation

By submitting this application, I hereby authorize you, Sierra Capital Incorporated, or it's agents, to investigate my financial responsibility and creditworthiness and will provide financial statements, tax returns, etc., as you - Sierra Capital Incorporated - deem necessary. I grant the right to procure any and all credit reports pertaining to any party to this application.

By:

Title:

Date:

PO Box 417, Hillsdale NY 12529
Phone (518) 325.3863, Fax (518) 325.3868

Application for Factoring Line of Credit

I Business Information

II Business History

III Bank and Credit Information

IV Receivable Information

V Tax Information

VI Getting Started

Fill out this application and submit it with the following supporting documents:

VII Prior to Funding

Prior to the initial funding, Sierra Capital will require the following documentation:

PO Box 417, Hillsdale NY 12529 Phone (518) 325.3863, Fax (518) 325.3868

Application for Factoring Line of Credit

I Business Information

II Business History

III Bank and Credit Information

IV Receivable Information

V Tax Information

VI Getting Started

Fill out this application and submit it with the following supporting documents:

VII Prior to Funding

Prior to the initial funding, Sierra Capital will require the following documentation:

PO Box 417, Hillsdale NY 12529
Phone (518) 325.3863, Fax (518) 325.3868