Factoring Application
Business Information
Business Information
Company Name
Address1
City
State
Zip
Phone #
Fax #
Federal ID or EIN#
DOT #
MC #
Contact Name
Title
Years in business
Months in business
Company Type
Select One
Corporation
Partnership
Sole Proprietor/DBA
LLC
# Trucks
Primary Freight Type
Email Address *
Owners
Owner 1
Name
Title
Social Security Number
Percentage of Ownership
Address1
City
State
Zip
Phone Number
Owner 2
Name
Title
Social Security Number
Percentage of Ownership
Address1
City
State
Zip
Phone Number
Additional Information
Additional Information
How Did You Hear About Us?
Have You Ever Factored Before?
Yes
No
Factoring Company Name
Do you have any UCC Filings or Liens on your business?
Yes
No
Insurance Agent Name
Insurance Agent Phone
Interested in Discounted Fuel Card?
Yes
No
Signature
Signature
**Please read and accept the terms below by checking the box
I hereby represent all information is true, correct and complete. I hereby authorize our banks, trade references, reporting agencies and financial institutions to release credit information to Finger Lakes Logistics, Inc. dba Integrated Logistics & Associates, its assigns and its affiliated companies. I also give permission to be added to company email lists with the option to Opt-Out at any time.
Signature *
Title *
Signature Date
Submit
