Apply Now Business Information Owner Information Owner/ Partner Information Processing Information Business Information Legal Corporation Name* DBA name Physical address* City,State, Zip Code* Entity Corp/LLC/Sole Prop* Telephone number* Tax id* Email* Website Length of ownership* Nature of business # Of Locations Products service sold Owner Name* Page : 1 of 4 Next Owner Information Owner title Seasonal business Yes No Tax liens Yes No Is the business for sale Yes No Currently in bankruptcy? Yes No Discharged bankruptcy in last 7 years? Yes No Are you in a cash advance now?* Yes No Notes (For Cash Advance Balances And Company Names) Requested funding amount '$' What will funds be used for Number of employees Own rent business location Own Rent Time remaining on lease Business Landlord Name Landlord Phone Any pending legal actions or claims? Yes No Monthly rent amount '$' Ownership % * Select Percentage 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 Home Address* City, State, Zip* Owner ssn* Owner DOB* Owner home phone Owner cell Do you own or rent your residence? Own Rent Driver License # State Issued Page : 2 of 4 Next Previous Owner/ Partner Information Owner name title Ownership % Home address City,State, Zip Code SSN Date of Birth Home phone Cell Do you own or rent your residence? Own Rent Drivers license State issued Page : 3 of 4 Next Previous Processing Information Do you accept cards Visa Visa Debit Mastercard Discover AMEX Pinpad debit Monthly card volume Number of terminals POS version High ticket Page : 4 of 4 SUBMIT Previous
