Avalon Funding Corportaion

Kindly fill out the application and submit it to info@avalonfunding.com. You can also fax it to (949) 298-4800.

Additional Information may be Required upon Initial Review of Your Application.

Company Name*

Street Address*

City*

State*

Zip*

Phone*

Email*

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Website*

Type of Business*

State in Which Company is Incorporated*

Name of Principal*

Name of Principal

Do you have any Federal or State taxes past due?

Yes

If yes, list type, quarter/year and amounts

What is your intended use of the funds generated?

Approximate number of customers

Average Monthly Sales (USD)*

Has your business ever acquired financing?*

Do you have any outstanding Merchant Cash Advances?*

How did you find out about Avalon Funding Corporation?

Briefly describe you business and financing needs

Articles of Incorporation

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Accounts Receivable Ageing

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Customer List

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Application