Consumer Contract Factoring Worksheet
Response Required Company Name
Response Required Company Address
Response Required Contact Person/Position:
Response Required Telephone Number:xxx-xxx-xxxx
Response Required Fax Number:xxx-xxx-xxxx
Response Required Two best times to reach you
Response Required Nature of Business
Response Required Structure of Business
Corp. Partnership Sole Other
Response Required How long in business?
Response Required Monthly Sales Volume($)
Response Required Annual Sales ($)
Response Required Average Contract Size ($)
Response Required Average Contract Terms(in months)
Response Required Average Interest Rate Charged
Response Required Average Credit Scores of Customers
Response Required Current Portfolio Size($) and number of contracts
Response Required Bank Loans ($)
Response Required Loan Collateral (if any)
Response Required Are you currently factoring, if so with whom?
Response Required Any other information that you wish to provide
Response Required Email address
Thank you. We will respond to you within 24 hours, if submitted on Sat. or Sun., we will respond by Monday. Your information is secure and confidential.
Please contact Fred Coutts with any questions at 206-281-3153 or 1-888-942-6639
Fax # 206-378-1070
Email Fred@FredCoutts.com
Web: www.FredCoutts.com
Please Click on the Submit Button to Send Your Information
All Boxes must be completed. You know you have submitted when the form says "Your Page has been Submitted"
Response RequiredIndicates Response Required