Your Sales Representative's Name (required)
Requested Advance Amount (required)
Intended Use of Funds (required)
Business Legal Name (required)
Business DBA Name
Address Line 1 (required)
Address Line 2 (Apt/Fl/Ste)
City, State & Zip (required)
Telephone (required)
Business Email (required)
Business Website
Type of Business Entity (required)
CorpLLCPartnershipSole PropOther
Federal Tax ID (required)
Estimated Annual Income (required)
Type of Business (required)
RetailRestaurantHotel/LodgingServicesInternet/eCommerceWholesale
Other
Full Name (required)
Official Title (required)
Phone (required)
Email (required)
Date of Birth (MM/DD/YYYY)
% Ownership
Full Name
Official Title
Address Line 1
City, State & Zip
Phone
Email
Date of Birth
Landlord/Mortgage Company (required)
OwnRent
Lease Expiration
Fax
Contact Name
Monthly Payment
Average Total Monthly Sales $ (required)
Average Total Monthly Visa/MC/AMEX Sales $ (required)
Ever have a cash advance?
YesNo
If yes, from who?
Current Balance $
Please describe any Suits, Judgements, or Liens (open or pending)
By submitting this application, you understand that financing is not guaranteed. You also agree to allow X2 Payment Systems, Capital Direct Merchant Services and EVO Payments to review your account.
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