Business Information Legal/Corporate Name:* DBA: Physical Address:* Mailing Address(if different from physical): Federal Tax ID: Date Business Started State of Incorparation Product/service Sold Type of Entity Sole ProprietorPartnershipCorporationLLCOther Have you contemplated filing bankruptcy in the last 12 months YesNo Type of Business RetailWholesaleBusiness ServicesConsumer ServicesRestaurant/BarOther Website Address Merchant / Owner Information Corporate Officer/Owner Name Title Email Address Lenth of Ownership (Yrs) (Mths) Home Address Ownership % DOB SS# Phone # Partner Information Corporate Officer/Owner Name Title Email Address Lenth of Ownership (Yrs) (Mths) Home Address Ownership % DOB SS# Phone # Business Property Information Business Landlord Contact Name Office/Mobile Number Do you own or lease? OwnLease Time at location Monthly Rent/Mortgage Date Lease Ends Business Trade References Name Phone Number Name Phone Number Credit Card Processing Information Current Processing Company Number of Terminals Phone Number Total Gross Sales Do you close the business part of the year YesNo Prior Merchant Cash Advance Company (if applicable) Current Balance (if applicable) Any federal/state tax liens on you or business? YesNo Any pending lawsuits on you or business? YesNo Is merchant account seasonal? YesNo If yes, list peak months (from - to)