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   Client Application   
Type of Business

Has business previously sold or factored Invoices, or are any liens on receivables?

Has the business, it's owners, or officers filed for bankruptcy?

Does business have a parent company, or own any subsidiary companies?

Is business or its owners involved in any lawsuits or litigation?

By checking the box below and entering the "Authorized Representative" information, I, individually and as an officer of the business, understand that Exchange Capital Corporation ("ECC") will rely on the information provided herein in its evaluation of the business's request.  I hereby warrant and represent that this information and any other information the business or I may supply ECC represents a correct, complete & accurate disclosure of all requested information on the business and does not omit any information, the omission of which would make the disclosed information misleading.  The information also includes information that would materially impact the financial data furnished.  I hereby authorize ECC to share credit information about our business with any affiliate or other party as permitted or required by law.  I also authorize ECC to perform required due diligence including, but not limited to, reference calls & accessing & viewing credit reports from sources it deems necessary.  I understand that knowingly providing false or misleading information to ECC or any of its officers or representatives may constitute a criminal offense.

Thanks for submitting the Excap Client Application. Someone will get back to you soon, and we're looking forward to working with you!

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