Receivables Based Financing

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Basic Details

Name:

Company:

Street:

Postal Code / City:

Line of Business:

Contact Person:

Telephone:

Fax:

E-mail:

Financials

Turnover in the Last Financial Year:

Profit in the last Financial Year:

Number of Regular Customers:

% of Turnover that is Domestic:

% of Customers which are Domestic:

Top 5 Customers

Name 1:

Name 2:

Name 3:

Name 4:

Name 5:

Turnover in last Financial Year 1:

Turnover in last Financial Year 2:

Turnover in last Financial Year 3:

Turnover in last Financial Year 4:

Turnover in last Financial Year 5:

Credit Insurance?

Yes / No:

-- Please Select -- Yes No

Insurer:

-- Please Select -- Euler Hermes Atradius Coface R+V AXA VHV Anderer

Policy Number:

Where Did you Hear About Us?

Search Engine?:

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Broker?:

Credit Insurer?:

-- Please Select -- Euler Hermes Atradius Coface R+V AXA VHV Anderer

Personal Referrer?:

General Advertisement?: