Monetrex

THE INFORMATION DERIVED FROM THIS QUESTIONNAIRE SHALL BE FOR THE EXCLUSIVE USE OF MONETREX INC. MONETREX CLIENT APPLICATION PART 1
1. How did you hear about Monetrex?
2. Full Name of Business:
Address:
City, State, Zip:
County:
Telephone:
Fax:
E-Mail:
State of Incorporation:
Federal Tax ID Number:
3. Type of Business:
4. How long have you been at this location?
5. Last business location (if within 3 years):
6. Key business owner:
Title:
Date of Birth:
Soc. Security Number: (optional)
Home Address:
City, State, Zip:
Home Phone:
County:
Percentage of Stock Ownership:
Common	%
Other:	%
Year started or took control of business:
7. Is this business a Startup or acquisition in last 5 years?
If so, describe:
8. Trade Names:
Present:
Former:
9. Key Operations Person or 2nd Key Owner:
Title:
Date of Birth:
Soc. Security Number: (optional)
Home Address:
City, State, Zip:
Home Phone:
County:
Percentage of Stock Ownership:
Common:	%
Other:	%
10. Present Directors:
11. Bank Name & Contact Person:
12. Approximate gross profit margin (computed as sales less direct costs, then divide by total sales)
Approximate Monthly Sales You Will Finance:
Typical Average Invoice:
Present Invoices You Would Finance Initially:
Average Customer Payment Period days:
13. Usual sales breakdown: (in percentages):
To Manufacturers:	%
To Wholesalers:	%
To Government Agencies:	%
To Other:	%
Describe:
14. Approximate Total Monthly Sales:	$
15. Typical number of employees?
Full-time
Part-time
16. What is non-owner key employee length of service?
Name
Length of Time
Duties
17. Other than equipment leases, do you have any loans or lines of credit secured by your receivables, inventory or equipment?
If so, explain:
1. Name of Lender:
Amount:	$
Current:
2. Name of Lender:
Amount:	$
Current:
18. Are there any tax liens against your company?
If so:
1. Taxing agency:
Amount:	$
Periods:
2. Taxing agency:
Amount:	$
Periods:
19. Other than tax liens, is the Company delinquent in paying any taxes (payroll, real estate, personal property, etc.)?
If so:
1. Taxing agency:
Amount:	$
Periods:
2. Taxing agency:
Amount:	$
Periods:
20. Financial Hardship
Is the Company in Bankruptcy right now?
If not in bankruptcy, have you authorized anyone to initiate bankruptcy proceedings or are you seriously considering such a filing?
Is the Company regularly participating in any formal or statutory installment payment arrangements with a large number of creditors, or have you authorized anyone to initiate this type of program?
Does the Company have a negative net worth (liabilities greater than assets)?
21. Has the business previously ever filed bankruptcy?
When?
22. Do you drop ship (send to 3rd party) merchandise for customers?
23. Do any of your vendors ship directly to your customers?
24. Are you interested in financing:
existing machinery and equipment?
inventory?
commercial real estate?
purchase orders?
25. Business Attorney (if any):
Name:
City/State:
Phone:
Fax:
26. Outside Accountant (if any):
Name:
City/State:
Phone:
Fax:
27. Outside Business Consultant (if any):
Name:
City/State:
Phone:
Fax:
28. Inside person to coordinate accounting questions:
29. Payroll & Payroll Taxes:
Do you use an outside service to prepare your payroll?
If so, which one?
How do you pay payroll taxes:
30. If Monetrex were to provide you working capital cash flow by using your current (under 90 days) invoices as collateral please choose:	Regularly, my business needs all funds that all of my invoices can generate Regularly, my business needs some funds from invoices, but does not need to finance all receivables all of the time
31. Are most of your sales to recurring customers?
32. What are your normal sales terms?
33. Do you offer discount terms to customers:
Describe:
34. Do any of your customers remit funds by Electronic Funds Transfer?
35. Do any customers require invoices electronically?
Which ones?
36. Top 3 to 5 customers account for what percentage of annual sales:	%
37. Is the business seasonal?
38. Approximate number of total active customers:
39. Freight policy:
40. Sale Transactions
If you sell a product, do you invoice:
If you furnish services, do you invoice:
If you are in the construction trades, do you invoice
41. How is most shipping documented?
42. Is there an employee union?
43. The amount of funds you need for:
Payoff bank or secured creditor
Delinquent payroll taxes
Equipment purchase
Inventory purchase
Back payroll
Trade payables
Payoff other loans
Other: (please describe)
44. Key Customers: (we will NOT contact them)
A. Customer Name:
Telephone:
City, State, Zip
Approximate Monthly Sales:
B. Customer Name:
Telephone:
City, State, Zip
Approximate Monthly Sales:
C. Customer Name:
Telephone:
City, State, Zip
Approximate Monthly Sales:
45. Are there any outstanding arrangements, agreements or circumstances which might or could cause "control" of the general business operations to change?
If yes, please explain:
46. Other than present loans, are there any outstanding arrangements, agreements or circumstances which could preclude the business from finalizing new financing
If yes, please explain:
47. Do you send out monthly account receivable statements?
48. Do you transact any business with your landlord or a subtenant?
49. Other than shareholders or commissioned salespeople, does any other person or entity have a participatory interest in the gross sales, profits, or financial activities of the Company?
If so, who?
50. To what trade associations do you belong (if any)?
51. Are you utilizing or considering using an employee leasing service?
52. What have been your historical annual bad debts?	% of sales
53. Is someoneâs bonus or commission dependent upon receivable collections?
Who?
54. Real Estate status:
If Leased:
Name of Landlord:
Monthly Rent:	$
Name of Tenant:
Date Lease Expires:
Is Lease Current:
Size of space:
55. Describe any foreign sales activity:
56. Approximate employee annual turnover
57. Do you store any materials or equipment for any customer or business relationship?
Please describe:
58. Do any customers require you to bar code any product or containers furnished to them?
59. Your invoice numbering system is:
60. For tax purposes, your fiscal year ends with which month?
61. Your customer base primarily is:
62. How would you rate your personal credit:
PLEASE HAVE AVAILABLE A COPY OF YOUR: ACCOUNTS RECEIVABLE AGING ACCOUNTS PAYABLE AGING FINANCIAL STATEMENTS (as recent as possible) SAMPLE OF ACTUAL INVOICE (with backup documentation) SAMPLE LETTERHEAD At a later time, we might request:* LIST OF LOANS (or leases) WITH MONTHLY PAYMENTS EQUIPMENT LIST BUSINESS PLAN OR CASH FLOW PROJECTIONS (if available) THE ABOVE INFORMATION IS ACCURATE TO THE BEST OF MY INFORMATION AND BELIEF. THE UNDERSIGNED GRANT PERMISSION TO MONETREX INC. TO MAKE PERIODIC INQUIRY OF CREDIT REPORTING SERVICES AND TO UNDERTAKE SIMILAR CREDIT SEARCHES NOW OR IN THE FUTURE CONCERNING THEIR INDIVIDUAL CREDIT HISTORY, INCLUDING AT ANY TIME THE ABOVE BUSINESS OR THE UNDERSIGNED ARE FINANCIALLY OBLIGATED TO MONETREX INC. (MUST BE SIGNED BY MAJORITY SHAREHOLDER AND ANY KEY CONTROLLING MANAGER.) By typing your name here, you agree to the above statements and information. Person #1 Person #2 © 2000 Monetrex Inc.