Get started today by completing this credit form. Click “send” and TemPay will begin the review process and get in touch with you. If you have questions, contact us at 1-866-6TemPay or info@TemPay.com

Owner 1

Name:
Title:
% of Ownership:
Social Security #:
Date of Birth:
Home Address:
City:
State:
Zip:
Driver's License #:
State:
Home Phone:
Cell Phone:
Email:
$ Personal Net Worth in Dollars:
Name of Banking Institution:
Owner 2

Name:
Title:
% of Ownership:
Social Security #:
Date of Birth:
Home Address:
City:
State:
Zip:
Driver's License #:
State:
Home Phone:
Cell Phone:
Email:
$ Personal Net Worth in Dollars:
Name of Banking Institution:
Confidential Business Information

Trade Name:
Company Name:
Address:
City:
State:
Zip:
Business Website:
Phone:
Fax:
Years in Business:
Type of Entity:  Sole Proprietor Partnership LLC Corporation
Current or Projected Sales: Sales Volume $ per
No. of Temporary Employees on Payroll:
Ave. Markup: %
Accounts Receivable: Average Turnaround Time Day
Outstanding Receivables %:
Business Classification: Clerical: % Industrial: % Medical: % Technical/Professional: %

The above information is willingly supplied and TemPay, Inc. is authorized to obtain credit information from any source (including but not limited to consumer reports from credit reporting agencies) about you individually (as authorized signer/owner/member/shareholder or otherwise principal business partner) and about the Business Entity in connection with the application and administration of any business services TemPay, Inc. may provide as a result of this application, to the extent not prohibited by law. This information will be held in strict confidence.

Owner1 Full Name: Date:
Owner2 Full Name: Date:
captcha
Type what you see: