Purchase Order Financing Application


Your Company:
Business Name:
Contact Name:
Title:
Street Address:
City:
State / Zip:
Country:
Phone:
Ext:
If outside USA, country code:
City code:
Fax:
Email:
Web site:
Description: Please provide a brief description of your company.
Are Your Customers:	Domestic Import Export
Where Are They Located:	North America South America Asia Europe Africa

What is your average monthly sales volume? $
How much of your average monthly billing do you wish to factor? (%)
Have you ever factored your receivables?	Yes No

If yes, with whom:

Total Accounts Receivable: $
Receivables > 90 days from invoice date: $
Does the Company or its Owners have any judgements or liens filed against them?	Yes No
Does the Company or its Owners have any pending law suits against them?	Yes No
Do you have any outstanding loans?	Yes No

If yes, with whom: Name of Financial Institution
Balance Owed: $

Do you have any UCC Filings:

Yes No

If yes, with whom:

Or are your receivables pledged as collateral:

Yes No

Please List Company's 3 Largest Customers You Wish To Factor (Note: Customers will NOT be contacted initially)
Company Name:
Monthly Sales: $
Average Invoice Amount: $
Company Name:
Monthly Sales: $
Average Invoice Amount: $
Company Name:
Monthly Sales: $
Average Invoice Amount: $

Buyer:
Company Name:
Address:
Address2:
City:
State / Zip:
Phone:
Fax:
Type of Finished Goods: Please describe

Supplier:
Company Name:
Address:
Address2:
City:
State / Zip:
Phone:
Fax:
Type of Goods: Please describe

Supplier Questions:
Have you purchased goods from this supplier in the past?	Yes No

What date will your supplier start producing the goods?

/ /

How much money does your supplier need to produce the goods?: $

How does your supplier get paid?

COD
Letter of Credit
Credit Terms
Other

How long will it take for your supplier to produce the goods	(days)
Do you need to take possession of the goods	Yes No
If Yes, what will you do with the goods.

If Yes - How long will it take to finish the goods	(days)
If Yes - After you finish the goods, how many days will it take to reach your buyer? From date of shipment	(days)
If No - How long does it take to get the goods shipped from your supplier to reach your buyer	(days)
Buyer Questions:
What is the amount of the purchase order from your buyer: $

What are the payment terms from the buyer

COD
Letter of Credit
Credit Terms
Other

What is the cancel date on the P.O. from your buyer	(days)
Can you get an extension from your buyer if you cannot produce the goods in time?	Yes No

Payment Terms: Is the Gross Margin 18% or greater	Yes No
If No, can you get your supplier to decrease the cost?	Yes No
If No, can you increase Buyer's Price?	Yes No
Do you want J&D to factor your receivables?	Yes No


If No, what lender will pay J&D for the purchase order money: Describe

Purchase Order Worksheet Example:
		Your Transaction
Buyer Purchase Price	75,000
Supplier Cost	45,000
Additional Cost:
Freight	4,000
Duty	2,500
Customs	500
Commissions	4,000
Bank L/C Charge	300
Other
Total Costs:	56,300
Gross Margin:	25%