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Disbursement Request And Authorization
DISBURSEMENT REQUEST AND AUTHORIZATION
BUYER:
[First name of buyer] [Last name of buyer]
[Company of buyer]
[Address of buyer]
[City of buyer], [State of buyer]
[Zip Code of buyer]
SELLER:
[First name of seller] [Last name of seller]
[Company of seller]
[Address of seller]
[City of buyer], [State of seller]
[Zip Code of seller]
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 <date of agreement], to the parties listed below in the amounts specified:
1. [first company]
$ [amount for first company]
2. [second company]
$ [amount for second company]
3. [third company]
$ [amount for third company]
4. [fourth company]
$ [amount for fourth company]
Total disbursements $ [Total disbursements]
Date of Authorization: [date of Authorization].
SELLER:
BY:
[President]