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BUSINESS INFORMATION
Legal-Corporate Name
DBA
Physical Address
City
State
Zip
Telephone #
Fax #
State of Incorporation
Federal Tax ID
Date Business Started
Length of Ownership
Website
Type of Entity (Select one)
Sole Proprietorship
Partnership
Corporation
LLC
Email Address
Type of Business (Select all that apply)
Retail
MOTO
Wholesale
Restaurant
Supermarket
Product/Service Sold
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MERCHANT/OWNER INFORMATION
Corporate Officer / Owner's Name
Title
Ownership %
Home Address
City
State
Zip
SSN
Date of Birth
Home #
Cell #
Loan Amount (if applicable)
Reasons for Loan (if applicable)
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PARTNER INFORMATION
Partner Name
Title
Ownership %
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City
State
Zip
SSN
Date of Birth
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Cell #
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PROCESSING
Processing Company
Terminal Type
Number of Terminals
Monthly Volume
Requested Advance Amount
Request Daily Witholding
Requested Process ACH/SPLIT
Prior Current Cash Advance company (if applicable)
Balance
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Contact Us
Call us:
+1 914-374-6220
Where to find us:
Buford GA 30518, United States
Business Hours
Mon - Sat
9:00 am
-
5:00 pm
Sunday
Closed
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