Online Application

Skip to content

Client Login
Submit a Referral
1-205-445-9445

Services
Industries
Partner
About Us
Resources
Apply Now
Search for:

Services
Industries
Partner
About Us
Resources
Apply Now
Search for:

Home
Services
Industries
Become a Partner
About Us
Resources
Request A Quote

Online ApplicationPorter Capital2024-04-24T13:00:36-05:00

Online Application

Use this online application to provide Porter Capital with detailed company information.

Legal Company Name *

DBA / Trade Name

Mailing Address

Mailing address same as primary business address

EIN / Federal Tax ID *

Year Established

County & State Established

Brief Company Description *

Type of Business *

S-Corporation
C-Corporation
LLC
Partnership
Sole Proprietor

Do any of the following apply?

Consignment Sales
Guaranteed Sales
Progress Billing
Milestone Billing
Bill and Hold Sales

Do you purchase goods or services from your customers?

Yes
No

Selling Terms

Net 30
Net 45
Net 60
Net 75
Other

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? *

Yes
No

Who is the lender and how much is owed?

Is your company current on taxes? *

Yes
No

How much is owed in taxes? *

Have you ever filed personal or business bankruptcy? *

Yes
No

Which type and what date(s)? *

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

Yes
No

Pending liens, judgements, or criminal records description *

Your Full Name *

Your Job Title *

Your Email *

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

Yes
No

What is your ownership percentage? *

Your Social Security Number *

Are there any owners of at least 20% of the company? *

Yes
No

Are there additional owners of at least 20% of the company? *

Yes
No

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Email *

Are there additional owners of at least 20% of the company? *

Yes
No

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Email *

Are there additional owners of at least 20% of the company? *

Yes
No

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Email *

Are there additional owners of at least 20% of the company? *

Yes
No

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Email *

Are there additional owners of at least 20% of the company? *

Yes
No

Owner Name *

Owner Job Title

Ownership Percentage *

Owner Social Security Number *

Owner Email *

Corporate Headquarters
2112 1st Ave N
Birmingham, AL 35203
205-322-5442

Nationwide Locations

Boca Raton, FL
Phone: 609-929-0194

Atlanta, GA
Phone: 404-216-5300

Minneapolis, MN
Phone: 205-397-1260

Services
Industries
Partner
About Us
Application

Privacy Policy and Terms of Service
PorterConnect Terms and Conditions

Facebook X LinkedIn Instagram

Page load link

Go to Top