CAPITAL NOW BUSINESS FUNDING APPLICATION
Merchant Services of America www.merchantservicesofamerica.com
1. BUSINESS INFORMATION
Legal Business Name:
CAPITAL NOW – BUSINESS FUNDING APPLICATION
Business Tax ID (EIN):
DBA Name (if different):
Physical Address:
City/State/Zip:
Business Phone:
Format: (000) 000-0000.
Industry/Type of Business:
Date Business Started:
-
Month
-
Day
Year
Date
2. FUNDING REQUEST & FINANCIALS
Requested Funding Amount: $
Estimated Monthly Sales:
Use of Funds:
3. OWNER/OFFICER INFORMATION
Owner Name:
Ownership Percentage:
% Home Address:
Email Address:
example@example.com
Mobile Phone:
Format: (000) 000-0000.
4. DOCUMENTATION
Please provide the following with your submission:
Most recent 3 months of business bank statements.
By signing below, the Merchant and its owners/principals (collectively, "Applicant") certify that all in- formation provided in this application is true and complete. Applicant authorizes Merchant Services of America and its partners/affiliates to obtain credit reports and other financial information from bu- reaus and third parties to evaluate this request for business funding. This is a request for funding, not an offer or guarantee of credit.
Authorized Signature:
Date:
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Month
-
Day
Year
Date
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SECTION 1: BUSINESS INFORMATION
Legal Business Name
DBA (Doing Business As)
Federal Tax ID (EIN)
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
Format: (000) 000-0000.
Business Email Address
example@example.com
5. LEGAL AUTHORIZATION (PLEASE READ)
Type of Business/Industry
Date Business Established
-
Month
-
Day
Year
Date
Number of Employees
SECTION 2: FUNDING REQUEST
Amount of Funding Requested
Average Monthly Revenue
Purpose of Funds
SECTION 3: OWNER/PRINCIPAL INFORMATION
Full Legal Name
First Name
Last Name
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Rows
Information
Title/Position
Ownership Percentage
Social Security Number
Date of Birth
Home Address
City, State, ZIP Code
Mobile Phone Number
Email Address
SECTION 4: REQUIRED DOCUMENTATION
Please submit the following documents with this application:
Most recent three (3) months of business bank statements (all pages)
Copy of valid government-issued photo ID (Driver's License or Passport)
Voided business check
SECTION 5: AUTHORIZATION AND CONSENT
By signing below, the undersigned Applicant ("Applicant") hereby represents, warrants, and agrees to
the following:
1. Truth and Accuracy of Information
All information provided in this application is true, complete,
and accurate to the best of Applicant's knowledge. Applicant understands that any false, misleading,
or incomplete information may result in immediate denial of this application or termination of any
funding agreement.
2. Authorization to Obtain Credit Information
Applicant hereby authorizes Merchant Services of
America, its affiliates, partners, successors, assigns, and any potential funding sources (collectively,
"Company") to:
Obtain consumer credit reports and business credit reports from one or more credit reporting
agencies;
Verify banking information, business revenue, and financial statements;
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Contact references, landlords, creditors, and other third parties to verify information provided;
Share application information with potential funding partners and financial institutions for the purpose of evaluating this funding request.
3. Nature of Application
Applicant acknowledges and understands that this application constitutes a request for funding consideration only and does not represent an offer, commitment, or guarantee of funding by the Company. Approval and terms of any funding are subject to the Company's sole discretion and underwriting requirements.
4. Communication Consent
Applicant consents to receive communications from the Company via telephone, email, text message, and mail regarding this application and related services.
5. Agreement to Terms
Applicant agrees that if approved for funding, Applicant will be bound by the terms and conditions set forth in any subsequent funding agreement executed between the parties.
SECTION 6: SIGNATURE
By signing below, I certify that I am an authorized representative of the business named above and that I have read, understand, and agree to all terms and conditions stated in this application.
Printed Name:
Signature:
Title:
Date:
-
Month
-
Day
Year
Date
FOR INTERNAL USE ONLY
FOR INTERNAL USE ONLY
Rows
Information
Application ID
Date Received
Reviewed By
Status
Merchant Services of America | Capital Now Funding Program
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Questions? Contact us at
www.merchantservicesofamerica.com
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