National Merchants Capital Application Form
Complete the quick form below to verify your business — and we’ll match you with the fastest funding options available. No obligations. Just real offers based on your revenue.
Business Information
Business Legal Name
*
Business DBA Name
(If Applicable)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
*
Mobile Number
*
Website
(If Applicable)
E-mail
*
example@example.com
Legal Entity
*
Please Select
LLC
Sole Prop
Corp
Partnership
Business Location
*
Please Select
Store Front
Office
Home
Other
Business Start Date
*
Industry
*
Federal Tax ID # / EIN #
*
Owner/Principle Information
Business Owner
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
% of Ownership
*
Date of Birth
*
Funding Information
Your Annual Business Revenue
*
Your Average Bank Balance
*
Funding Amount Requested
*
Use of Funds
*
Current Advance Balance
(If Applicable)
Daily Payment of Current Advance
(If Applicable)
Current Advance Held With
Funding Date of Current Advance
Signature
Submit
Owner #2 (Required if Applicable)
Business Owner
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
E-mail
example@example.com
% of Ownership
Date of Birth
Signature
Should be Empty: