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{\f14\fnil\fcharset2\fprq2{\*\panose 05000000000000000000}Wingdings;}{\f68\froman\fcharset238\fprq2 Times New Roman CE;}{\f69\froman\fcharset204\fprq2 Times New Roman Cyr;}{\f71\froman\fcharset161\fprq2 Times New Roman Greek;}
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\snext0 Normal;}{\*\cs10 \additive Default Paragraph Font;}{\s15\qc\nowidctlpar\tldot\tx9187\tx10800\adjustright \b\f1\fs26 \sbasedon0 \snext15 Title;}}{\info{\title Client Profile}{\author Karen Knott}{\operator RommelM}
{\creatim\yr1998\mo7\dy6\hr15\min57}{\revtim\yr2001\mo6\dy8\hr14\min5}{\printim\yr1998\mo4\dy23\hr12\min36}{\version3}{\edmins0}{\nofpages1}{\nofwords448}{\nofchars2555}{\*\company Pino Training Organization}{\nofcharsws0}{\vern113}}
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{\pntxtb (}{\pntxta )}}\pard\plain \s15\qc\nowidctlpar\tldot\tx9187\tx10800\adjustright \b\f1\fs26 {Client Profile
\par }\pard\plain \sl300\slmult0\nowidctlpar\tldot\tx6739\tldot\tx9187\tx10800\adjustright \fs20 {\b\f1 CCFC/Broker Information
\par }{\f1 Name___________________________Company_____________________________ Date_________
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\tx10800\adjustright {\f1 Address \tab 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tx5040\tldot\tx9187\tx10800\adjustright {\f1 City__________________State________ ZIP_______Phone _______________Fax_______________}{\b\f1 
\par 
\par Client Information}{\f1 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\tx10800\adjustright {\f1 Legal company name\tab 
\par dba name (if applicable\tab 
\par Present address \tab 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tx5040\tldot\tx9187\tx10800\adjustright {\f1 City ____________________ County____________________ State ________ZIP________________
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\f1 Phone\tab   Fax\tab ___________________________________
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx9187\tx10800\adjustright {\f1 Contact _______________________________  Title________________________________________ 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\f1 Structure    }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1  Corporation      }{\f1 {\field{\*\fldinst SYMBOL 111 \\f 
"Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1  Partnership      }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1  Sole Proprietorship    }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{
\f1  LLC           Date est.______
\par State of Incorporation________ Date of Incorporation_______ Federal Tax ID/SSN________________
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\tx10800\adjustright {\f1 Business description\tab 
\par Has Client ever factored receivables? }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1  No        }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1  Yes (with whom?)\tab 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx9187\tx10800\adjustright {\f1 Does Client or its Principals have any:   }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1   Judgments     }{\f1 {\field{\*\fldinst SYMBOL 111 \\f 
"Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1    Liens     }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1   Back taxes     }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1 
  Lawsuits  
\par      (Check all that apply and attach details).
\par Does Client have any outstanding loans?  }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1  No         }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1 
 Yes (name of institution)__________________
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\f1 Balance owed $_________________    Are receivables pledged as collateral?     }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1 
 No       }{\f1 {\field{\*\fldinst SYMBOL 111 \\f "Wingdings" \\s 10}{\fldrslt\f14\fs20}}}{\f1   Yes
\par }{\b\f1 
\par }\pard \sl360\slmult0\nowidctlpar\tldot\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\b\f1 Principals of Company}{\f1 
\par }\pard \sl360\slmult0\nowidctlpar\tx2160\tldot\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\f1 Name/title\tab                 Home address                                                        Social Security #
\par }\pard \nowidctlpar\tx3052\tx6652\tx7372\tldot\tx9187\tx10800\adjustright {\f1 __________________________ \tab ______________________________________\tab  ____-___-_____
\par __________________________ \tab ______________________________________\tab  ____-___-_____
\par __________________________ \tab ______________________________________\tab  ____-___-_____
\par }\pard \nowidctlpar\tx2160\tldot\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\f1 __________________________   ______________________________________   ____-___-_____  
\par }\pard \sl360\slmult0\nowidctlpar\tx2160\tldot\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\f1 \tab 
\par }{\b\f1 Bank References}{\f1  \tab                                                    
\par }\pard \nowidctlpar\tx2160\tldot\tx4680\tx5220\tldot\tx9187\tx10800\adjustright {\f1 Name of institution __________________________ Address_________________________________
\par Phone ___________________ Contact____________________ Check/loan acct.#________________ Name of institution __________________________ Address__________________________________
\par Phone ___________________ Contact____________________ Check/loan acct.#________________\tab 
\par }\pard \sl360\slmult0\nowidctlpar\tx2160\tldot\tx4680\tx5392\tldot\tx9187\tx10800\adjustright {\b\f1 Principal Customer Information}{\f1 
\par Please list client\rquote s five largest customers client wishes to factor. Customers will not be initially contacted.
\par }\pard \nowidctlpar\tx2160\tldot\tx4680\tx5392\tldot\tx9187\tx10800\adjustright {\f1\fs18                                                                                                                                       
\par }\pard \nowidctlpar\tx2160\tldot\tx9187\tx10800\adjustright {\f1\fs18 Monthly Sales/Average Invoice                     Name                                  City / State                          Phone}{\f1 
\par }\pard \sl300\slmult0\nowidctlpar\tx2160\tx2692\tx5302\tx7372\tldot\tx9187\tx10800\adjustright {\f1 $__________/___________\tab ______________________   _________________   ________________
\par $__________/___________\tab ______________________ \tab _________________\tab ________________
\par $__________/___________\tab ______________________ \tab _________________\tab ________________
\par $__________/___________\tab ______________________ \tab _________________\tab ________________
\par }\pard \sl300\slmult0\nowidctlpar\tx1972\tx2332\tx4672\tx7012\tx7912\tldot\tx9187\tx10800\adjustright {\f1 $__________/___________   ______________________   _________________   ________________}{\i\f1 
\par }\pard \sl300\slmult0\nowidctlpar\tx2152\tx4672\tx7012\tx7912\tldot\tx9187\tx10800\adjustright {\i\f1 
\par Attach the following: (1) Copy of Articles of Incorporation & By-Laws or Copy of Partnership Agreement, (2) Copy of Fictitious Name Filing (if applicable) and (3) Accounts Receivable Aging.}{\f1 
\par 
\par /clientpr}{
\par }}