Business Funding Application

BUSINESS INFORMATION

Legal/corporate name

DBA

Physical address

Street Address

City

State

Zip Code

Country

Business phone

Fax

Federal tax ID

Contact

Website

Date business started

Length of ownership

Years at location

# of locations

B. OWNERSHIP

Must have at least 67% ownership, if NOT, add additional owners on additional applications

Name

Contact phone number

Home address

Street Address

City

State

Zip Code

Country

Date of birth

SSN

% Ownership of company

Must have at least 67% ownership - Title

C. LEASE

Landlord Information

Landlord name

Contact

Monthly rent

Phone

E. BUSINESS PROFILE

Ownership

Sole proprietorship

Corporation

Partnership

LLC

Cards accepted

Visa

MasterCard

American Express

Discover

F. CASH ADVANCE

Amount requested: (We provide up to 2 times a companies gross monthly bank revenue).

Average Visa/MasterCard monthly sales

Average gross monthly sales

Average ticket size

Have you used a cash advance plan before?

If so, what company did you use?

Original Balance

Current Balance? (Provide Original Contract)

Current payment or daily holdback%

G. OTHER INFORMATION

Current processing company

H. SIGNATURE

By signing below, the Merchant and its owners/principals:

(1) certify that all information on and documents submitted in connection with this Application are true, correct, and complete; and

(2) authorize M&P, its agents, partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners/principals from third parties, in order to verify any information provided on the Application.

Print Name

Date

Requested Documents

Choose File