Gulf Coast Business Credit: Invoice Factoring & Accounts Receivable Finance Company

Welcome to Gulf Coast Bank & Trust Co.'s asset based lending & factoring division. You are about to complete our application for approval. The approval process will take 24 hours. Make sure you don't miss any questions or omit any information but please don't let any one question deter you from applying. If a question we are asking doesn't apply to your company, simply skip that question and move on. The more complete your application, the better chance you will be approved for a lower rate. Should you have any questions regarding this application, please contact our main line at 866-577-8867 or email us at gcbcinfo@gulfbank.com. We look forward to working with you.

General
Information
Financial
Information
Ownership
Information
Professional
Services
Review &
Submit

Business Name:*

Business Phone:*

Business Fax:

Business Street Address:*

City:*

State/Province:*

Zip Code:*

Business Mailing Address:

City:

State/Province:

Zip Code:

County:
Organization Type:*
Number of Owners:
Type of Business:

General Description:

Date Business Established:
State of Organization/State Entity Formed:*

Federal E.I.N./T.I.N. (if applicable):

Charter Number:
Are you currently factoring?
If so, with whom?
Does the company have any IRS liens or past-due IRS obligations?
If yes, is there a payment plan or subordination currently in place?
Does the company accept credit card payments from customers?

Anticipated Annual Sales / Revenue:

Facility Size Requested:

Average Number of Invoices Per Month:

Average Invoice Size:

Projected Monthly Funding Volume:

Invoice Terms:
Sales Generated Via Purchase Order?:
Sales Generated Via Contract?:
Sales Generated Via Other?:
Invoicing At Completion?:
Invoicing At Shipment?:
Invoicing at Delivery?:
Invoicing Progressively?:

For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and ManagersManager

Sole Proprietor - Owner, Corporate SecretaryN/A - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers

Officer/Principal First Name:*
Officer/Principal Last Name:*

Percent Ownership:

Title:
Date of Birth:
Email:*

SSN (Owner/Principal):

Mobile:
Home Phone:
Address (Owner/Partner Home Address):
City (Owner/Principal Home Address):
State (Owner/Principal Home Address):
Zip Code (Owner/Principal Home Address):

For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers

Officer/Principal First Name:
Officer/Principal Last Name:

Percent Ownership:

Title:
Date of Birth:
Email:

SSN (Owner/Principal):

Mobile:
Home Phone:
Address (Owner/Principal Home Address):
City (Owner/Principal Home Address):
State (Owner/Principal Home Address):
Zip Code (Owner/Principal Home Address):

For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers

Officer/Principal First Name:
Officer/Principal Last Name:

Percent Ownership:

Title:
Date of Birth:
Email:

SSN (Owner/Principal):

Mobile:
Home Phone:
Address (Owner/Principal Home Address):
City (Owner/Principal Home Address):
State (Owner/Principal Home Address):
Zip Code (Owner/Principal Home Address):

For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers

Officer/Principal First Name:
Officer/Principal Last Name:

Percent Ownership:

Title:
Date of Birth:
Email:

SSN (Owner/Principal):

Mobile:
Home Phone:
Address (Owner/Principal Home Address):
City (Owner/Principal Home Address):
State (Owner/Principal Home Address):
Zip Code (Owner/Principal Home Address):

For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers

Officer/Principal First Name:
Officer/Principal Last Name:

Percent Ownership:

Title:
Date of Birth:
Email:

SSN (Owner/Principal):

Mobile:
Home Phone:
Address (Owner/Principal Home Address):
City (Owner/Principal Home Address):
State (Owner/Principal Home Address):
Zip Code (Owner/Principal Home Address):

For each corporate entity type, these are the required individuals whose contact information we need to complete this form.

Corporation - Director, Officer, Corporate Secretary

Limited Liability Company (LLC) - Members and Managers

Sole Proprietor - Owner, Corporate Secretary - For 3rd officer page, please enter ”N/A” in all fields.

Partnership - Owner, Corporate Secretary, Managers

Officer/Principal First Name:
Officer/Principal Last Name:

Percent Ownership:

Title:
Date of Birth:
Email:

SSN (Owner/Principal):

Mobile:
Home Phone:
Address (Owner/Principal Home Address):
City (Owner/Principal Home Address):
State (Owner/Principal Home Address):
Zip Code (Owner/Principal Home Address):

Bank Contact First Name:
Bank Contact Last Name:
Bank Contact Title:
Bank Name:
Bank Contact Phone Number:
Loans
Attorney First Name:
Attorney Last Name:
Attorney Company Name:
Attorney Phone Number:
Accountant First Name:
Accountant Last Name:
Accountant Company Name:
Accountant Phone Number:

General Information

Business Name:

Business Phone:

Business Fax:

Business Street Address:

City:

State/Province:

Zip Code:

Business Mailing Address:

City:

Zip Code:

State/Province:

County:

Organization Type:

How many Owners:

Type of Business:

General Description:

Date Business Established:

State of Organization/State Entity Formed:

Financial Information

Federal E.I.N./T.I.N:

Charter Number:

Are you currently factoring?:

If so, with whom?:

Does the company have any IRS liens or past due IRS obligations?:

If yes, is there a payment plan or subordination currently in place?:

Does the company accept credit card payments from customers?:

Annual Sales/Revenue:

Facility Size:

Average Number of Invoices Per Month:

Average Invoice Size:

Invoice Terms:

Sales Generated Via Purchase Order?:

Sales Generated Via Contract?:

Sales Generated Via Other?:

Invoicing At Completion?:

Invoicing At Shipment?:

Invoicing At Delivery?:

Invoicing At Progressively?:

Ownership Information

Owner 1

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Owner 2

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Owner 3

Officer/Principal First Name:

Officer/Principal Last Name:

Percent Ownership:

Title:

Date of Birth:

Email:

SSN (Owner/Principal):

Mobile:

Home Phone:

Address (Owner/Partner Home Address):

City (Owner/Principal Home Address):

State (Owner/Principal Home Address):

Zip Code (Owner/Principal Home Address):

Professionial Services

Bank Contact First Name:

Bank Contact Last Name:

Bank Contact Title:

Bank Name:

Bank Contact Phone Number:

Loans:

Attorney First Name:

Attorney Last Name:

Attorney Company Name:

Attorney Phone Number:

Accountant First Name:

Accountant Last Name:

Accountant Company Name:

Accountant Phone Number:

Financial Information

Submitted By First Name:
Submitted By Last Name:
Submitted By Title:
Submitted By Email:*

Gulf Coast Business Credit: Invoice Factoring & Accounts Receivable Finance Company

Application

Gulf Coast Quick Quote

General Information

Financial Information

Ownership Information

Owner 1

Owner 2

Owner 3

Owner 4

Owner 5

Owner 6

Professionial Services

Financial Information