Application - Mazon Associates

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Mazon Associates, Inc. Application

To establish an account with us, fill out the online application below or complete our downloadable application. Once you’ve submitted the information we will review it and contact you for further instruction.

Mazon Application Long Form

Company Information

Legal name of company

Business address

Street address

City

State

Zip code

Do you have a different mailing address?

No

Yes

Mailing address

Street address

City

State

Zip code

Do you have a company website?

No

Yes

Website

Business description

Year established

Federal Tax ID

Type of business

State Incorporated

LLC Tax Classification

1. Principle / Member / Owner

First name

Last name

Suffix

Title

Ownership %

%

Phone

Social Security #

Date of Birth

Drivers License #

Drivers License State

Residence address

Street address

City

State

Zip code

Do you own or rent your residence?

Own

Rent

Add a Second Principle, Member or Owner?

No

Yes

2. Principle / Member / Owner

First Name

Last Name

Suffix

Title

Ownership %

%

Phone

Social Security #

Date of Birth

Drivers License #

Drivers License State

Residence address

Street address

City

State

Zip code

Do you own or rent your residence?

Own

Rent

Add a Third Principle, Member or Owner?

No

Yes

3. Principle / Member / Owner

First Name

Last Name

Suffix

Title

Ownership %

%

Phone

Social Security #

Date of Birth

Drivers License #

Drivers License State

Residence address

Street address

City

State

Zip code

Do you own or rent your residence?

Own

Rent

Add a Fourth Principle, Member or Owner?

No

Yes

4. Principle / Member / Owner

First Name

Last Name

Suffix

Title

Ownership %

%

Phone

Social Security #

Date of Birth

Drivers License #

Drivers License State

Residence address

Street address

City

State

Zip code

Do you own or rent your residence?

Own

Rent

Financial Information

Avg. monthly revenue ($)

Current total A/R balance ($)

Avg. invoice amount ($)

Total factoring amount needed per month ($)

Please list your largest customers that you want to factor:
(Don't worry, we won't contact your customers without your persmission.)

1. Customer name

Current account balance ($)

Avg. collection days

Factoring amount needed ($)

2. Customer name

Current account balance ($)

Avg. collection days

Factoring amount needed ($)

3. Customer name

Current account balance ($)

Avg. collection days

Factoring amount needed ($)

Other Information

Does your company currently have any outstanding debt?

No

Yes

Please list any outstanding debts you owe:
(Include Bank loans, SBA loans, MCA's, Private debt, etc.)

1. Name of debtor

Amount owed ($)

Type of collateral

2. Name of debtor

Amount owed ($)

Type of collateral

3. Name of debtor

Amount owed ($)

Type of collateral

Does your company or officers have any past due taxes?

No

Yes

Please list any past due taxes you owe:
(Include Federal, State and Local taxes)

1. Name of tax agency

Amount owed ($)

2. Name of tax agency

Amount owed ($)

3. Name of tax agency

Amount owed ($)

Does your company or officers have any past bankruptcies?

No

Yes

Year of last bankruptcy

Does your company or officers have any pending lawsuits?

No

Yes

Please explain any pending lawsuit:

Are you currently factoring?

No

Yes

Name of the factoring company

Electronic Signature

Your first name

Your last name

Title

Your work phone

Your mobile phone

Your email

Date

Authorization
The confidential information contained in this application is true and correct, and I hereby authorize any credit investigation necessary by Mazon Associates, Inc.

Factoring club best of 2024 award

contact us

800 W. Airport Frwy.
Suite 900
Irving, TX 75062

(800) 442-2740

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About Us
Services
Resources
Contact Us
Client Login

About Us
Services
Resources
Contact Us
Client Login