Lexx Funding, Inc. - Improve Cash Flow, Support Growth, Increase Profits. The Source For Business Capital.
 
 

Our Factoring Application is available below.  You can either send your information using the online form or you can download the PDF file, print the form, fill out all information and and efax to 1-636-787-0543 or mail to:

Lexx Funding, Inc.
358 Turnberry Place Drive
Wildwood, Missouri 63011

Download Factoring Application PDF File

Our online form will send your information to our email.  Your personal information will remain strictly confidential with us.  All fields must be filled in.  If not applicable, please put "no" or "none".  At the end of this form we have listed several items that we will need efaxed to us at 1-636-787-0543 to complete your application.

Legal Name of Company as listed on Articles of Incorporation
DBA, if applicable
Address
City
State
Zip
Phone
Fax
Cell
Website
Company is a:
Federal Tax ID
Please list any prior companies or other names used over the past 5 years:
Date Business Started
Number of years under same ownership
State of Incorporation
Nature of Business
Are you listed by Dunn & Bradstreet? Yes No
If yes, please list number
Is office space owned or leased? Owned Leased
Monthly rental amount
Are there any judgments or liens filed against you, any company principals or the corporation? Yes No
If yes, please explain

CURRENT FINANCING
Do you have outstanding loans or lines of credit? Yes No
If yes, please provide the Lender, Amount Outstanding, Collateral, Contact & Phone 
Have you ever financed or factored any of your receivables? Yes No
If yes, with whom?
Are you currently with them? Yes No
If yes, provide the current amount open
Are you still submitting invoices? Yes No
Are you currently leasing any of your equipment? Yes No
Provide the name of leasing company
Are you current on your lease obligations? Yes No N/A
If no, please explain
Please list any other types of financing

BANKING INFORMATION 
Name of Bank
Date account opened
Number of accounts
Business Checking Account Number
Do you maintain a separate payroll account? Yes No
Contact Person Name, Title, Phone & Fax Numbers

COLLATERAL INFORMATION 
Purchase date of current premises
Purchase Price
Down Payment
Monthly Payment
Term of Finance
Interest rate
Balloon date (if applicable)
Purchase date of additional premises
Purchase Price
Down Payment
Monthly Payment
Term of Finance
Interest rate
Balloon date (if applicable)
Are receivables generated from the sale of goods, services or both? Goods Services Both
Number of active customers
Number of invoices per month
Normal Selling Terms
Any extended items offered?
Average monthly sales
Last year's sales
Any security interest granted that covers accounts receivables and/or inventory?

TAX INFORMATION 
Do you utilize a payroll and/or PEO service? Yes No
If yes, please name
How often do you file 941 payroll taxes? Weekly Monthly Quarterly
Annually
Are your Federal/State payroll taxes current? Yes No
If no, please list type, amount & quarters delinquent
Are the Officers and/or Principals delinquent in any tax obligations? Yes No
If yes, please explain

PROFESSIONAL REFERENCES 
Attorney
Phone
Accountant
Phone
How did you hear of Lexx Funding, Inc.?

TRADE/CUSTOMER INFORMATION
Please list your company's five largest trade creditors.
 (Include Company Name, Phone, Fax, City, State, Date Account Opened, Product and/or Service Provided & High Credit for each)
Trade Creditor One
Trade Creditor Two
Trade Creditor Three
Trade Creditor Four
Trade Creditor Five

Please list your company's five largest trade customers.
(Include Company Name, Phone, City, State, Monthly Sales, & Average Invoice Amount for each)

Customer One
Customer Two
Customer Three
Customer Four
Customer Five

OFFICER/PRINCIPLE INFORMATION
Full Name
Home Address
City, State & Zip
Social Security Number
Title
Ownership %
Have you declared bankruptcy in the last 10 years?  Yes No
Full Name
Home Address
City, State & Zip
Social Security Number
Title
Ownership %
Have you declared bankruptcy in the last 10 years?  Yes No

SUPPORT DOCUMENTATION
The following information is needed by Lexx Funding, Inc., to determine the feasibility of entering into one or more financing arrangements with our lending institutions.  Please efax the following to 1-636-787-0543 after submitting the online form.

  • Copy of Articles of Incorporation (showing legal business name and identities of corporate president, secretary, and/or treasurer.

  • Accounts receivable summary listing invoice from invoice date (please provide up-to-date information).

  • Accounts payable summary (please provide up-to-date information).

  • Most recent financial statements (if available) and in detailed format.

  • Sample invoice or billing form(s).

  • Last 6 months of bank statements (summary pages only).

The foregoing information is true and correct to the best of my knowledge and is given to Lexx Funding for the express purpose of determining the feasibility of obtaining financing.  I hereby do authorize Lexx Funding or its agents, assigns, lenders, lessors or funding sources to verify and investigate any and all of the foregoing statements, including but not limited to, my/our credit worthiness and financial responsibility, in any way they may choose.  I/We grant Lexx Funding the right to procure any and all credit reports pertaining to any party listed in this application, but not limited to, all principals of the applicant company.  By entering my name below, I am duly authorized by the parties above to grant this permission on behalf of the applicant company and its owner and officers.
PREPARED AND CONSENTED BY:
Name
Title
Date
 

 

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