application

Please fill out the application below and submit your documentation to initiate the funding process.

  • Fill out the application below
  • Upload your last 4 business bank statements
  • Upload your last 4 statements of credit card processing (if you process credit cards)
  • Sign the form using your mouse
  • Submit the form

 

BUSINESS INFORMATION

Business Name* :
DBA :
Address* :
Your Email* :
Phone* :
Fax :
Federal Tax Id :
Date Business Started :
Length of Ownership* :
Website :
Type of Entity* :
Type of Business :
Products/Services Sold :
Have you previously filed for bankruptcy?* :
If yes, when? :
Have you ever received a merchant cash advance?* :
If yes, from what vendor? :
How many employees do you have? :
Who is your payroll services provider? :

MERCHANT/OWNER INFORMATION

Corporate Officer/Owner Name* :
Title :
Ownership %* :
What is your personal FICO (credit) score?* :
Home Address* :
SSN* :
Date of Birth* :
Home Phone :
Cell Phone* :
Do you own any other businesses? :
If yes, please list the names of the other businesses :

PARTNER INFORMATION

Partner Name :
Title :
Ownership % :
Home Address :
SSN :
Date of Birth :
Cell Phone :

BUSINESS PROPERTY INFORMATION

Do you own or rent your business location?* :
Business Landlord or Business Mortgage Bank :
Contact Name and/or Account # :
Phone :

Upload your last four months bank and/or credit card statements below

Bank Statement 1 :
Bank Statement 2 :
Bank Statement 3 :
Bank Statement 4 :
Credit Card Statement 1 :
Credit Card Statement 2 :
Credit Card Statement 3 :
Credit Card Statement 4 :
Additional Documents 4 :

Additional Products

Are you interested in any of the following small business solutions?* :
AccountingCredit Card ProcessingCredit RepairPayroll ServicesI am not interested at this time

AGENT USE ONLY

Notes :
Requested Advance Amount :
Requested Daily Withholding :
Monthly Volume :
Prior/Current Cash Advance Company (if applicable) :
Balance :

By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize Capital Merchant Advances One, LLC ("CMA and each of its representatives, successors, assigns and designees ("Recipients") that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, "Transactions") to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize PMF to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to PMF and to each of the Recipients, on its own behalf.

Date* :

Applicants Signature

By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize Capital Merchant Advances One, LLC ("CMA and each of its representatives, successors, assigns and designees ("Recipients") that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, "Transactions") to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize PMF to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to PMF and to each of the Recipients, on its own behalf.