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Cash Advance Application
Sales Agent Name *
Doing Business As (DBA) Name *
Business Address *
Mailing Address (if different) *
Main Business Phone *
Business Email *
Business Website
How Many Locations? *
Type of Business *
Business Start Date *
MM
/
DD
/
YYYY
Business Legal Name (i.e. Inc., LLC, etc.) *
Legal Entity *
State Incorporated
Federal Taxpayer ID / EIN # # - # # # # # # #
Additional Information
Total Gross Monthly Sales (Cash/Check/Credit Cards) *
How much money would you like to request? *
Does your business accept credit cards? *
Who's your Credit Card Processor currently? (if applicable)
Is your business seasonal? *
If Yes, check HIGH season months
Do you Own or Rent Business Property? *
Monthly Rent/Mortgage $ Amount of Business Property *
Any prior bankruptcies? *
Any tax liens or judgements? *
Any current loans or advances? *
If Yes, how many loans or advances do you have open?
What is the current balance of each as of today?
How much are your daily payments? (If monthly payback, divide by 21)
OWNER #1 / PRINCIPAL INFORMATION
Owner #1 Full Name *
Owner #1 Title *
Owner #1 Home Address *
Owner #1 Preferred Contact Phone *
Owner #1 Mobile *
Owner #1 Email *
Owner #1 Ownership % *
Owner #1 Driver License # *
Owner #1 Date of Birth *
Owner #1 Social Security Number *
OWNER #2 / PARTNER INFORMATION
Owner #2 Full Name
Owner #2 Title
Owner #2 Home Address
Owner #2 Preferred Contact Phone
Owner #2 Mobile
Owner #2 Email
Owner #2 Ownership %
Owner #2 Driver License
Owner #2 Date of Birth
Owner #2 Social Security Number
Special Requests/Comments
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