CLIENT PROFILE

ABOUT THE COMPANYBUSINESS LEGAL NAME: EMPLOYER ID #:

TYPE OF ENTITY ( ONE): STATE OF INCORPORATION:

NATURE OF BUSINESS: DATE STARTED: # EMPLOYEES:

ADDRESS: CITY:

PHONE: FAX:

DOES THE COMPANY: OWN RENT THE PROPERTY?

LANDLORD’S NAME:

INSURANCE AGENT: PHONE:

ANY PAST DUE TAXES? HAS A LIEN BEEN FILED? ANY LIENS ON RECEIVABLES?

ANY BANK LOAN OR LINE OF CREDIT? IF YES, WITH WHOM?

If your answer is YES to any of the three questions above, please explain on a separate page and attach here. Attach

DOCUMENTATION NEEDEDFor purposes of pre-approval, please supply the following information (additional financial information may be requested later):

CURRENT AGING OF ACCOUNTS RECEIVABLE

COPY OF CURRENT INVOICE WITH BACKUP (PO, contract, proof of delivery, etc.)

AND

THE SHAREHOLDERS Please account for 100% ownership. Attach separate page if necessary.

I understand this is not an application for credit. The intent of this profile is for you to determine if a relationship between our two companies would be mutually beneficial. I authorize Amerisource Funding, Inc. (“ASF”) to investigate the information I have supplied on this profile. I further authorize ASF to access any credit reporting agencies in its investigation of me, or my company. I appoint ASF and its assigns as my agent and attorney-in-fact to sign and file UCC Financing Statements for the purpose of protecting its security interest under any agreements and transactions relating to our firms.

PRINT NAME

X

DATE

TITLE

HOW SOON DO YOU WANT TO BEGIN USING OUR SERVICES?

WHO REFERRED YOU?

1st Independent Leasing3800 S.W. Cedar Hills Blvd • Suite 165 • Beaverton, OR 97005

503.626.3486 • 503.626.1631 Fax • www.1stindependentleasing.com REV. 01/18

STATE: ZIP:COUNTY:

PHONE:

NAME:

DRIVER LICENSE #: STATE ISSUED:

SSN:

DOB:

PHONE:

EMAIL:

HOME ADDRESS:

CITY:

OWNERSHIP %:TITLE:

OWN RENT

STATE: ZIP:

NAME:

DRIVER LICENSE #: STATE ISSUED:

SSN:

DOB:

PHONE:

EMAIL:

HOME ADDRESS:

CITY:

OWNERSHIP %:TITLE:

OWN RENT

STATE: ZIP:

CORPORATION PARTNERSHIP SOLE PROPRIETORSHIP

CLIENT PROFILE

1st Independent Leasing3800 S.W. Cedar Hills Blvd • Suite 165 • Beaverton, OR 97005

503.626.3486 • 503.626.1631 Fax • www.1stindependentleasing.com REV. 01/18

AVG MONTHLY SALES: $ AVG # OF INVOICES/MONTH:

AVG TIME FOR INVOICE TO PAY (DAYS): NORMAL PAYMENT TERMS:

PRODUCT WARRANTY: CONSUMER A/R:DOES YOUR INVOICING INVOLVE:SEASONALITY:CUSTOMER DEPOSITS:

GOVERNMENT SALES: SALES TO AFFILIATES:STATEMENT BILLING:

IF YOU HAVE ANSWERED YES TO ANY OF THE QUESTIONS ABOVE PLEASE EXPLAIN IN DETAIL HERE.

APPROXIMATELY HOW MANY CUSTOMERS DO YOU HAVE? IS YOUR CUSTOMER BASE STATIC OR DO YOU CONSTANTLY SERVE NEW CUSTOMERS? WHAT IS YOUR PERCENT OF REPEAT CUSTOMERS VS. PERCENT OF NEW CUSTOMERS?

TELL US MORE ABOUT YOUR BUSINESSHOW DO CUSTOMERS PLACE ORDERS? (CHOOSE ONE): WRITTEN PO VERBAL PO CONTRACT

OTHER:

PROVIDE AN EXAMPLE OF YOUR INVOICE AND OTHER DOCUMENTS YOUR CUSTOMER REQUIRES TO PAY THE BILL. DESCRIBE IN DETAIL YOUR BILLING PROCESS FROM INVOICING TO COLLECTION.

WHAT DOCUMENTS DO YOU USE TO CONTRACTUALLY BIND YOUR CUSTOMERS (I.E. CONTRACTS, PURCHASE ORDERS, OR OTHER SIGNED DOCUMENTS)? PROVIDE A COPY OF EACH TYPE.

WHAT ARE YOUR PAYMENT TERMS? LIST ALL AND IF MULTIPLE, GIVE A PERCENT EACH IS USED.

DO YOU HAVE RETURN MERCHANDISE/PRODUCT? EXPLAIN WHY, INCLUDING AN APPROXIMATE PERCENTAGE OF RETURNS.

DESCRIBE THE FREQUENCY OF CREDIT MEMOS AND WHAT PERCENT OF ANNUAL SALES REVENUE THEY REPRESENT.

DESCRIBE HOW CREDIT MEMOS ARE HANDLED (I.E. DO THEY RELATE TO SPECIFIC INVOICES).

DO YOUR CUSTOMERS MAKE “ON ACCOUNT PAYMENTS” WHEN PAYING MULTIPLE INVOICES WITH ONE CHECK OR DO THEY REFERENCE SPECIFIC INVOICE NUMBERS WHEN MAKING PAYMENTS?

ANY WORK IN PROGRESS, MILESTONE, OR PERCENTAGE OF COMPLETION BILLING? YES NO

DO YOU EVER INVOICE CUSTOMERS WHILE STORING GOODS ON YOUR PREMISES?

DO YOU SELL ON CONSIGNMENT OR HAVE ANY ‘GUARANTEED’ SALES?

DO YOU BUY FROM ANY COMPANIES THAT YOU ALSO SELL TO?

YES NO

YES NO

YES NO

DO YOU INVOICE PRIOR TO DELIVERY/SERVICE? YES NO

YES NOYES NOYES NOYES NO

YES NOYES NO

YES NO