DISBURSEMENT REQUEST AND AUTHORIZATION

 

 

BUYER:      _____________________________________ (Company)

                     _____________________________________ (Address)

                     _____________________________________

 

SELLER:     _____________________________________ (Company)

                     _____________________________________ (Address)

                     _____________________________________

 

Seller understands that no proceeds will be disbursed until all of Buyers conditions for making the initial advance have been satisfied. Buyer is hereby directed to and authorized to release the proceeds under that certain Factoring Agreement by and between Seller and Buyer dated ________(month & day), ______(year) to the parties listed below in the amounts specified:

 

1.    _____________________________________ (Co.)     $__________________

2.    _____________________________________ (Co.)     $__________________

3.    _____________________________________ (Co.)     $__________________

4.    _____________________________________ (Co.)     $__________________

 

Total Disbursements                                                              $___________________

 

Date of Authorization:  _________________

 

SELLER:  __________________________________ (Co.)

 

BY:  _______________________________________

        (President)