Online Application

Business Name*

Date Business Established *

Business Address *

Business Phone*

Mobile Phone*

Fax Number

Email*

MC Number*

Fleet Size*

Legal Status of Business*

Federal Tax ID

Taxes Past Due*
YesNo

If Yes, Type & Amount

Tax Lien Filed*
YesNo

Personal Taxes Past Due*
YesNo

Officer/Owner Name*

Percentage Owned*

Driver's License Number

Home Address *

Officer/Owner Name 2

Percentage Owned 2

Driver's License Number 2

Home Address 2

Do You Currently Factor?*
YesNo

If Yes, With Whom?

Have You Factored Before?*
YesNo

If Yes, With Whom?

Credit Limit Requested?

How Did You Find Out About Tetra?

Authorization
I understand that the submission of this application to Tetra Capital, LLC (hereinafter Tetra) does not obligate Tetra to factor/finance or provide any financial services whatsoever. The above statements are true and correct to the best of my information and belief. This serves as my permission for the release of any information to Tetra regarding this application for the purpose of credit investigation. I hereby authorize Tetra to investigate the credit of all parties listed above. I also herein authorize Tetra to contact our customers to verify payment history.

Items that will be required to complete the setup of a new account
Please email or fax the following to Sales@tetracapital.com or 877-734-1051

Articles or Organization or Proof of Ownership for all Owners
Customer List/Accounts Receivable
3-5 Trade References
W-9 Form
Liability & Cargo Insurance Certificate (name Tetra Capital as Certificate Holder)
Copy of a Voided Check
Copy of Operating Authority
Copy of Applicant(s) Driver's License(s)

Initials*


Tetra Capital