Cash Advance Request Form

Cozart Capital Merchant Cash Advance Application

Please submit all the required information in the form to recieve cash advance loan terms and be contacted by our underwriting team.
Business Name
Business Address
Years in Business
Business Monthly income
Business Telephone number
Website
Business Email
EIN Number (Optional)
Bank Name ( Where to deposit Funds)
Routing number
Account number
Amount Requested
Owner Full Name *

First Name Last Name
Address
Date of Birth
Social Security Number ( Optional)
Phone Number *

Area Code Phone Number
E-mail *
State ID

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Cancel of
Recent Bank Statement 1

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Cancel of
Recent Bank Statement 2

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Cancel of
Recent Bank Statement 3.

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Cancel of
Signature

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By submitting this application you agree to the terms and condition. Cozart Capital will look over your application and offer you a merchant cash advance based on the information you provided. You Authorized Cozart Capital/ Hudson Lee Crowd Fund/ GFE and or its affilates to Run your Business and or Business credit for loan purposes.

We operate 24 hours 7 days per week and will get back to you with terms in 24 hours.
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Cozart Capital Merchant Cash Advance Application