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Office Phone number
Type of Company
Number of Customers on Aging
Average Invoice Amount
Standard Invoice Terms
If customer concentration exists (e.g., 40% of AR is with one customer) please provide details
Do You Have Credit Insurance?
Most Recent Month-end AR Aging Balance
Number of Years In Business
Desired Amount of Credit Line?
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Type of Credit Line
Has the Lender Sent You a Notice of Termination?
Questions or Comments?
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