NFDA - C&J Financial

Name

First Last

Firm Name*

Address*

Street Address City State ZIP Code

Phone*

Fax

Email*

Authorized Contact Person at Your Firm*

Name

Business Tax ID Number*

Type of Business*

State Issued Funeral Establishment License Number*

(please fax a photo copy of state issued license to 866.785.0030 or email to Accounts@CJF.com)

How did you hear about C&J?*

Has your firm previously used an assignment funding company?*

The funding fee is a cashless transaction that is deducted from the amount assigned. How is the fee going to be handled by your firm?*

If referred by another funeral home client, please let us know who

Referring Sales Representative

Preferred Method of Payment*

Direct Wire Transfer ($15 wire fee) - Funds are wired to your bank for Immediate use
ACH Deposit - Funds deposited for next business day credit. Holidays and weekends will delay receipt of funds.

Additional Information, Requests or Promo Code:

Email

This field is for validation purposes and should be left unchanged.