Thank you for your interest in
Apex Capital Corp as your factoring partner!
After we receive the following information, we can
customize a program that will meet your company’s needs.
Please fax the following to 817-806-2244:
 Completed and Signed Application
 Copy of Driver’s License
 Operating Authority
 Insurance Certificate
 W-9 Form
 Articles of Incorporation or Organization (if applicable)
 Aging/list of current clients or prospective clients (including customer’s
city, state, and main phone number)
6000WesternPlaceSuite1000•FortWorth,TX76107•Phone:(800)511‐6022•Fax:(817)806‐2244
Fax completed applications to:
817-806-2244
CLIENT CREDIT APPLICATION
Complete Legal Name:
Trade Name:
Physical Address:
City:
State:
Zip:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Business Est Date:
EIN#:
MC#:
Legal Status:
Corporation / LLC (Date Est.
County:
State
Do you currently have or have you applied for broker authority?
# of Company Owned Trucks:
)
Yes
Partnership

No

Sole Proprietorship
# of Owner-Operated Trucks:
Type of Trailers (vans, flats, etc):
What do you haul?
Has This Company Ever Factored or Pledged its Accounts Receivables?
Yes

No

Is This Company’s Accounts Receivables Currently Factored or Pledged?
Yes

No

If either answer above is “YES”, to whom have you factored or pledged?
Do you currently have a fuel card?
Yes

No

If “YES”, with whom?
How did you hear about us?
THIS SECTION REFERS TO YOUR CUSTOMERS
Accounts Receivables Total:
Current:
Average Monthly Sales:
31-60 Days:
# of Active Customers:
Are you currently receiving “quick pays” from brokers?
Yes
 No 
61+
Average Inv. Amount:
# of Active Customers?
THIS SECTION REFERS TO THE OWNERS, OFFICERS, AND/OR DIRECTORS OF YOUR COMPANY
Officer/Owner #1
Full Name:
First
Middle
Last
Jr./Sr./Etc.
Home Address:
City:
State:
Home Phone:
Date of Birth:
Zip Code:
Cell:
Title:
Ownership%:
Social Security #:
The information supplied in this Client Credit Application, and all forms and documents in connection herewith are true and correct to the
best of my knowledge and belief. I hereby authorize the release of credit information to Apex Capital Corp for the purpose of credit
evaluation.
By:
Title:
Date:
Signature of Officer/Owner #1
Apex Capital LP  6000 Western Place, Suite 1000, Ft. Worth, TX 76107  (800) 511-6022  FAX (817) 806-2244  www.apexcapitalcorp.com
Fax completed applications to:
817-806-2244
Officer/Owner #2:
Full Name:
First
Middle
Last
Jr./Sr./Etc.
Home Address:
City:
State:
Home Phone:
Zip Code:
Cell:
Date of Birth:
Title:
Ownership%:
Social Security #:
The information supplied in this Client Credit Application, and all forms and documents in connection herewith are true and correct to the
best of my knowledge and belief. I hereby authorize the release of credit information to Apex Capital Corp for the purpose of credit
evaluation.
By:
Title:
Date:
Signature of Officer/Owner #2
Officer/Owner #3:
Full Name:
First
Middle
Last
Jr./Sr./Etc.
Home Address:
City:
State:
Home Phone:
Zip Code:
Cell:
Date of Birth:
Title:
Ownership%:
Social Security #:
The information supplied in this Client Credit Application, and all forms and documents in connection herewith are true and correct to the
best of my knowledge and belief. I hereby authorize the release of credit information to Apex Capital Corp for the purpose of credit
evaluation.
By:
Title:
Date:
Signature of Officer/Owner #3
Officer/Owner #4:
Full Name:
First
Middle
Last
Jr./Sr./Etc.
Home Address:
City:
State:
Home Phone:
Date of Birth:
Zip Code:
Cell:
Title:
Ownership%:
Social Security #:
The information supplied in this Client Credit Application, and all forms and documents in connection herewith are true and correct to the
best of my knowledge and belief. I hereby authorize the release of credit information to Apex Capital Corp for the purpose of credit
evaluation.
By:
Title:
Date:
Signature of Officer/Owner #4
Apex Capital LP  6000 Western Place, Suite 1000, Ft. Worth, TX 76107  (800) 511-6022  FAX (817) 806-2244  www.apexcapitalcorp.com
Fax completed applications to:
817-806-2244
Apex Capital LP  6000 Western Place, Suite 1000, Ft. Worth, TX 76107  (800) 511-6022  FAX (817) 806-2244 
www.apexcapitalcorp.com