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C Mart Technologies PRE QUAL Cash Advance Application
Sales Representative Name *
Your answer
Business Legal Name *
Your answer
Business DBA Name *
Your answer
Business Legal Address *
Your answer
Main Business Phone Number *
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Business Email Address *
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Website
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Type of Business *
Products and Services Sold *
Your answer
Legal Entity *
State Incorporated
Federal Taxpayer ID / EIN # # - # # # # # # #
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OWNER #1 / PRINCIPAL INFORMATION
Owner #1 Name *
Your answer
Owner #1 Title *
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Owner #1 Date of Birth *
Your answer
Owner #1 Email *
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Owner #1 Phone *
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Owner #1 Mobile *
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Owner #1 Address *
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Owner #1 City *
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Owner #1 State *
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Owner #1 Zip Code *
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Owner #1 Ownership % *
Your answer
Length of Ownership (Yrs/Mos) *
Your answer
Owner #1 Social Security Number *
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Owner #1 Driver License # *
Your answer
OWNER #2 / PARTNER INFORMATION
Owner #2 Name
Your answer
Owner #2 Title
Your answer
Owner #2 Date of Birth
Your answer
Owner #2 Email
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Owner #2 Phone
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Owner #2 Mobile
Your answer
Owner #2 Address
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Owner #2 City
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Owner #2 State
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Owner #2 Zip Code
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Owner #2 Ownership %
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Length of Ownership (Yrs/Mos)
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Owner #2 Social Security Number
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Owner #2 Driver License
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Additional Information
How much money is being requested? *
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Last year's total gross sales: *
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How many employees in business *
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Does business accept credit cards? *
How does business occupy location: *
Is business up to date on rent, lease, or mortgage payments? *
Is business seasonal? *
If Yes, first and last month of HIGH season
Your answer
If Yes, first and last month of LOW season
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Has business ever used cash advances before? *
If yes, what company provided cash advance?
Your answer
When did business receive advance?
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Amount advanced?
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Balance due?
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Any prior bankruptcies? *
If yes, date is was entered into discharged, closed or dismissed
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Any tax liens or judgements? *
If yes, is there a payment plan for this lien or judgement?
Special Requests/Comments
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