Working Capital & Factoring Application

Financing Request

Type of Financing Requested *

Amount Requested ($) *

Use of Funds *

Business Information

Business Full Legal Name *

Trade Name / Operating Name

Website

Mailing Address *

City *

Prov/State *

Postal/Zip *

Country *

Phone *

Fax

Contact Name / Title *

Email *

Date Incorporated *

Yrs Under Present Owner

GST or Federal ID Number *

No. of Employees

Structure: Corporation Partnership Proprietorship Other

Annual Sales ($) *

Number of Active Accounts

Owner / Guarantor #1 *

Name *

Title *

% Owned *

Phone

Date of Birth *

Home Address *

Own Home Rent

SIN (Canada) or SSN (US) — Optional

Owner / Guarantor #2 (if applicable)

Name

Title

% Owned

Phone

Date of Birth

Home Address

Additional Questions

Any owners involved in bankruptcy?

Business in arrears for taxes?

Bank References

Bank Name *

Officer

Account #

Phone

Existing Line of Credit?

With Whom?

Facility Limit ($)

Trade References

Provide 2-3 trade references

Firm Name

Contact

Phone

Firm Name

Contact

Phone

Accounts Receivable Information

Complete this section if applying for factoring or receivables financing

Outstanding Receivables ($)

Terms of Sale

Average Monthly Sales ($)

Number of Active Accounts

Amount of Invoices to Sell ($)

Then $ Per Month

Receivables Pledged as Collateral?

If Yes, to Whom?

Supporting Documents

Last 2 Years Financial Statements (Optional)

Upload your most recent 2 years of financial statements or tax returns to help speed up your approval, or email them to info@alliancefinancing.ai with your Tracking Number after submission.

Drag and drop financial statements here, or click to select

PDF, PNG, JPG — max 10MB per file

Current & Aged AP / AR Reports (Optional)

Upload your current accounts payable and accounts receivable aging reports. These are especially important for factoring applications.

Drag and drop AP/AR aging reports here, or click to select

PDF, PNG, JPG — max 10MB per file

E-Signature & Authorization

Print Your Full Legal Name (Electronic Signature) *

By typing your name above and submitting this application, you are electronically signing this document. This electronic signature is legally binding and has the same effect as a handwritten signature under the Personal Information Protection and Electronic Documents Act (PIPEDA) and applicable provincial and state laws.

Signature date & time: Will be recorded on submission

Thank You for Your Application!

Your application has been successfully submitted.

Your Tracking Number:

Please save this tracking number for your records.

Our team will review your application and contact you within 24–48 business hours.

📍 Track Your Application

Visit our website to check the status of your application at any time:

Visit AllianceFinancing.ai

📎 Supporting Documents

To get your application started, please forward the following to info@alliancefinancing.ai with your Tracking Number in the subject line:

Completed credit application
Last 2 years of financial statements including interims to current
Current and aged accounts payable and accounts receivable

Our credit team will contact you if any additional documentation is required.

Working Capital & Factoring Application

Last 2 Years Financial Statements (Optional)

Current & Aged AP / AR Reports (Optional)

Thank You for Your Application!

📍 Track Your Application

📎 Supporting Documents

📞 Your Agent Contact

💬 Questions?