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Get Funded Today, Get More Cash, Faster, and at the best price!
Freight Bill Funding
Factoring
265 E Main Street, D-145, Kaysville UT 84037Tel: 866-780-5009 | Fax: 855-331-8880
Brock Transportation has a long history in the transportation industry, from owning and operating trucks to running a successful brokerage. We know the di�culties in the industry.
Factoring can help your business manage expenses like fuel, payroll,and maintenance while waiting for customers to pay. Instead of waiting 30 to 60 days to get paid,
receive same-day funding and let us take care of the rest.
OUR FOCUS
Get you the best rate possible.Understand your business needs.Increase Cash FlowImmediate Funding
Prompt & Personal Service - someone on your side.
“There is just no way our company could have grown the way it has withoutfactoring with one of Brocks Partners. ” -K- President of Trucking and intermodal
“Brocks Partner is the �rst and only factoring company we have worked with sinceI started my company in 2005. They are �exible, management is stable and they follow through on what they say they are going to do. “ -S- President Trucking
BENEFITS OF PARTNERING WITH BROCK
Funding within hoursNo hidden feesAs much as a 95% advance on a customer invoiceEasy application and approval processRecourse and non-recourse programsLow funding ratesCollections team Fuel advances on certain programs
Complete the attached application
FAX | 855-331-8880 EMAIL | [email protected]
CALL | 866-780-5009
Is it taking too long to get your money?
the answer...Brock Factoring!
pg. 1
Full Legal Name of Business
Prior Business Names Used & Associated Businesses
Address City State Zip
Phone # Fax # Contact for Factoring
Years in Business Date of Incorporation State of Incorporation County
Bank Name Account # Phone #
Contact Title Email
US Dot # MC # Fed ID #
Describe your Business (check all that apply) Common Carrier Contract Carrier Broker Dedicated
Number of Power Units Owned Number of Trailers Number of Owner Operators leased to you
Number of Trucks/Owner Operators expected to add (over next 6 months)
How did you hear about Brock Factoring? Do you have a Fuel Card account? Yes No If yes, with who?
Check all that apply to applicant: Bank Credit Line/Loan SBA Loan Liens LawsuitsJudgements Tax Liens Bankruptcy UCC Filings None Apply
Your Avg. Receivable Balance (last 30 days) Your Avg. Invoice Amount Amt Intended to Factor on a Monthly Basis
How soon do you need to start Factoring?
Have you or any Principal ever factored receivables? Yes No If yes, with whom?
Are you or any Principal currently in a factoring relationship? Yes If yes, contract expiration date
1. Customer List – Please provide Customer Name, Address, Phone Number & Credit Limit2. Accounts Receivable Aging Report 5. Copy of drivers license for all principals
3. Copy of MC Authority and copy of Insurance Certificate4. Articles of Incorporation and/Fictitious name Filing(s)/DBA
1. Owner Name/Title: Home Phone: DOB:
Address, City, State, Zip: SSN: % Owned: 2. Owner Name/Title: Home Phone: DOB:
Address, City, State, Zip: SSN: % Owned: 3. Owner Name/Title: Home Phone: DOB:
Address, City, State, Zip: SSN: % Owned: 4. Owner Name/Title: Home Phone: DOB:
Address, City, State, Zip: SSN: % Owned:
Signature of Proprietor, Partner or Corporate Office
Print Name Date
Transportation Application
265 E Main Street, Suite D145, Kaysville, UT 84037
Tel. 866-780-5009 Fax 855-331-8880
Business Operations
Account Receivables
Essential Documents to be Submitted
�Business Ownership (Account for 100%)
General Information
No
Permission is herewith granted to obtain credit information from all listed references including my bank. All financial information submitted in support of this new account and credit application is true and complete in all aspects. I/We hereby consent and authorize the use of my consumer credit report in the credit evaluation process.
By signing this credit application and using services of Brock LLC and/or Partners, I certify that I am authorized to make this request on behalf of this company. Brock LLC and/or Partners is authorized to file a UCC Financing Statement against all assets of Applicant(s) upon execution of this Application. I assume personal and individual responsibility and liability and guaratee payment of all charges due and payable to Brock LLC and/or Partners by the company or corporation listed herein.
pg. 2
*Please attach a separate sheet if you intend to factor more than 10 clients
A/R Outstanding Currently $
Approximate # of Customers
1. Owner Name Title
Signature2.
3.
4.
Transportation Application
265 E Main Street, Suite D145, Kaysville, UT 84037
Tel. 866-780-5009 Fax 855-331-8880
Customer/Broker List (include all companies you intend to factor)
Business Ownership Signatures (signatures required for all individuals listed in the ownership section)
FINANCING DETAILSAverage Invoice Amount $
Average Monthly Sales $
# Name MC Number Telephone Number Current Balance Outstanding
1
2
3
4
5
6
7
8
9
10
Date
Owner Name Title
Signature Date
Owner Name Title
Signature Date
Owner Name Title
Signature Date
PLEASE RETURN TO BROCK LLC ONCE COMPLETED
FAX: 855-331-8880EMAIL: [email protected]
I/We certify, represent and warrant that the statements made in and documents attached to this application are true and accurate to the best of my/our knowledge and belief.
I/We authorize Brock LLC and/or Partners to file a UCC Financing Statement against all assets of Corporate , Applicant(s) and any individual(s) signing this application for purposes of protecting it's security interest. This authorization will be valid so long as applicant has an outstanding balance with Brock LLC and/or Partners. Brock LLC and/or Partners will release the UCC Financing Statement if financing is not provided pursuant to this application.
I/We authorize Brock LLC and/or Partners to procure credit reports, verifications and other information which, in its sole discretion, is deemed appropriate for completing its credit evaluation. Furthermore I/We provide authorization, on a continuing basis for any person or business to release any and all credit reports or verification to Brock LLC and/or Partners.
