Supplier Eligibility Form

Company Details

Registered Company Name

Date of Incorporation

Country of Incorporation

Company Registration number

Company Website url

Contact Name

Contact Email

Products / Services sold

Thank you for your interest in Incomlend.

This form will gather the information necessary to confirm your eligibility as a supplier of invoices. All information provided will be treated in the strictest confidence and used only for the purpose of evaluating the suitability of your business for the Incomlend Invoice Trading Platform.

You can save this application at any time and complete it in stages.

Contact Phone
please include country code

Financial Statements

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Buyer Financial Statements

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Your Buyers' Details

Please indicate the details of the Buyers for who you intend to finance your receivables through the Platfrom.
All fields are mandatory, except Registration number (however it would accelerate the process if it could be indicated).
If you have more than 3 Buyers to indicate, please fill in the "Additional Buyers" field at the end.
If you have only 1 or 2 Buyers, please leave the additional sets of fields empty.

Buyer 1

#1 Company Name
This field is mandatory

Company Address
This field is mandatory. If the country of the company's address is not in the drop down list, please indicate it in the "Region" field.

Company Registration number
This field is not mandatory but highly recommended to get accurate insurance feedback

Contact Phone
please include country code

Finance Contact Name

Invoicing Currency

Expected yearly revenue with buyer
in invoicing currency

Expected number of invoices a year

Expected average financing period

Buyer 2

#2 Company Name
This field is mandatory

Company Address
This field is mandatory. If the country of the company's address is not in the drop down list, please indicate it in the "Region" field.

Company Registration number
This field is not mandatory but highly recommended to get accurate insurance feedback

Contact Phone
please include country code

Finance Contact Name

Invoicing Currency

Expected yearly revenue with buyer
in invoicing currency

Expected number of invoices a year

Expected average financing period

Buyer 3

#3 Company Name
This field is mandatory

Company Address
This field is mandatory. If the country of the company's address is not in the drop down list, please indicate it in the "Region" field.

Company Registration number
This field is not mandatory but highly recommended to get accurate insurance feedback

Contact Phone
please include country code

Finance Contact Name

Invoicing Currency

Expected yearly revenue with buyer
in invoicing currency

Expected number of invoices a year

Expected average financing period

Additional Buyers

Please indicate your additional Buyers if any in this field

Verification