Factoring Client Application

Please note that all information provided will remain confidential and will not be disclosed to any third party.

General

ACCOUNTS RECEIVABLE

CUSTOMERS TO BE FACTORED

OWNERSHIP

LIST ALL OWNERS, PARTNERS, OFFICERS, ETC..

OWNERSHIP #2

OWNERSHIP #3

OWNERSHIP #4

OTHER

By submitting this application, the person(s) listed above agree to the following:

The statements contained herein and the documents attached hereto are true and accurate to the best of my (our) knowledge and belief. We authorize PF Funding, LLC to obtain information regarding employment, bank accounts, and/or outstanding credit and to file the appropriate UCC Financing Statements. We authorize any consumer or commercial credit reporting agency, business or person to provide any such information regarding us or our business as may be necessary in consideration of this application. This authorization will be valid for two (2) years from the date below. A photocopy of this authorization will be as valid as the original.