Online Application Form | Porter Capital

Company Information (continued)

Brief Company Description *

Type of Business *

Do any of the following apply?

Do you purchase goods or services from your customers?

Selling Terms

Other Selling Terms Description

How much was last year's revenue?

How much is this year's revenue so far?

What are your average monthly sales?

Do you have any secured debt, factoring, merchant cash advances, or bank debt? *

Who is the lender and how much is owed?

Is your company current on taxes? *

How much is owed in taxes? *

Have you ever filed personal or business bankruptcy? *

Which type and what date(s)? *

Do you have any pending liens, judgements, or criminal records? *

Pending liens, judgements, or criminal records description *

If you choose to upload an accounts receivable aging report, it can help our underwriters process your application more quickly.

(Optional) Upload a detailed accounts receivable aging report

Click or drag a file to this area to upload.

Your Full Name *

Your Job Title *

Your Email *

Your Phone Number *

Are you an owner of at least 20% of the company? *

What is your ownership percentage? *

Your Social Security Number *

Your Date of Birth *