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Merchant Application

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Step
Step

Legal Business Name

DBA

Amount Requested

Company's Monthly Revenue

Business Phone #

Physical Address

City

State

Zip Code

Web Site URL

Federal Tax ID

Date Business Started

Number of Locations

Ownership Type

Merchant Type

Number of Owners

State of Registration

Rent or Own

Monthly Rent/Mortgage

Landlord/Leasing Agent Name

Landlord Phone

Owner #1 (Required)

Home Address

City

State

Zip Code

Date of Birth

Social Security #

Drivers License #

Drivers License State

% Ownership

Receivables

Monthly Cash Deposit Average

Monthly Credit Card Deposit Average

Monthly Cash Deposit Frequency

Average Credit Card Batches per Month

MCA Balances

Funder Name

Current Balance

By checking this box & submitting this form, the Merchant (Applicant) represents that all information is being willfully provided to Merchant Cash Group (Group) and that it is full, complete and accurate. Applicant also acknowledges that the Group is not a lender and does not provide business funding or credit decisions. The Group agrees to use the information provided on this application, as well as any financial statements submitted for the sole purpose of obtaining an offer for business funding for the Applicant from a direct funder (Lender). Applicant authorizes the Group to provide this application, as well as any other financial, personal, or business-related documents submitted to the Group to potential Lender(s) and further authorizes the Lender(s) to contact and receive information on Seller from banks, financial institutions, credit bureaus and investigative agencies, both personal and business, and to investigate such information and the references and any other statements, information or data provided to the Group by the Applicant. Any offer for funding and its corresponding contractual agreements will be between the Lender(s) and the Applicant solely, and the Group shall not be responsible for any of the Applicant’s obligations as outlined in said agreements.

Finished!

Your application process has been completed. A representative will be contacting you shortly at .

If you'd like to expedite the process you can call us at (877) 296-3782.