Completing the Business Application indicates that you are interested in finding out more about a factoring program that is suitable to fit your company needs. There is absolutely no obligation. Your information will never be redistributed to 3rd parties.
A company representative will contact you promptly to go over the various programs that meet your qualifications based on the submitted information. Should you have any questions please call (800) 360-4446 or email us for more information. To fax us an application, click here.
Company Information
Enter your contact and company information.
Your E-mail:
Company Name:
Address:
City:
State:
Zip Code:
Telephone #:
Fax #:
Legal Status:
Truck Status:
MC #:
USDOT #:
Date Established:
Federal ID No:
# of Employees:
Does the company have any Federal or State
taxes past due?
Yes
No
If Yes, name of agency?
If Yes, payment plan?
If Yes, has a lien been filed?
Yes
No
Current A/R Balance:
$
Amount Funding Needed:
$
Are the company's accounts receivable pledged as collateral to any party?
Yes
No
Owners, Officers or Partners:
Enter information on main executives and managers.
First / Last Name:
Title:
Home Address:
City:
State:
Zip Code:
Telephone #:
Date of Birth:
Percentage of Company Ownership:
%
First / Last Name:
Title:
Home Address:
City:
State:
Zip Code:
Telephone #:
Date of Birth:
Percentage of Company Ownership:
%
First / Last Name:
Title:
Home Address:
City:
State:
Zip Code:
Telephone #:
Date of Birth:
Percentage of Company Ownership:
%
Account Information
Enter information on the accounts you wish to factor with OCC.
Customer Name:
Address:
City:
State:
Zip Code:
Phone:
Approximate Credit Needed:
$
Current Balance:
$
Customer Name:
Address:
City:
State:
Zip Code:
Phone:
Approximate Credit Needed:
$
Current Balance:
$
Customer Name:
Address:
City:
State:
Zip Code:
Phone:
Approximate Credit Needed:
$
Current Balance:
$
The above statements are true and accurate to the best of
my information and belief. This serves as my permission for
the release of any information to Orange Commercial Credit regarding
this application for the purpose of credit investigation. I
hereby authorize Orange Commercial Credit to investigate the credit
of all parties listed above.
Name and Title of person submitting this
application:
Fax Business Application to OCC The OCC Business Application is available as an Acrobat Reader / PDF document, allowing you to print and fax the application to OCC. Click here to download the business application, then print, fill in your information, and fax to OCC at (714) 938-0933.
