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Name: *
Phone: *
Email: *
Business Name: *
Business Type
Please Select
Accounting
Aerospace
Architect
Auto / Truck Dealership
Auto Repair/Parts
Bar/Nightclub
Beauty Salon / Spa / Tanning
Bio Tech
Business to Business Services
Child Care
Chiropractor
Computer Hardware/Software
Construction
Consulting
Consumer Products
Couriers/Messengers
Dentist
Distribution
Education Related
Electronics
Energy
Entertainment
Environmental
Financial Services
Fitness
Franchise Other
Funeral Home
Gambling Establishments
Gaming
Gasoline Station
Health Products
Import/Export
Industrial Products / Wholesale
Insurance
Internet/Online Services
Legal Profession
Manufacturing
Media Production
Medical/Healthcare
Natural Resources
Other
Pharmacy
Printing
Publishing
Real Estate Related
Resorts/Hotel/Motel
Restaurant
Restaurant - Franchise
Retail Stores
Security
Service Related
Staffing
Technology/Telecom
Titled Vehicles
Transportation
Veterinarian
Warehousing/Storage
Waste or Recycling
Wine & Liquor Sales
Years in Business
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20+
What is your business average monthly Gross Revenue?*
Please Select
$1 - $2,000
$2,001 - $5,000
$5,001 - $10,000
$10,001 - $20,000
$20,001 - $50,000
$50,001 - $100,000
$100,001 - $200,000
above $200,000
What are your total monthly Visa and MasterCard Sales?*
Please Select
$1 - $2,000
$2,001 - $5,000
$5,001 - $10,000
$10,001 - $20,000
$20,001 - $50,000
$50,001 - $100,000
$100,001 - $200,000
above $200,000
None – Need Options
Are you renewing with MCC?
No
Yes
Comments:
Merchant Cash and Capital's qualification application
Apply Now for a Business Cash Advance. After You Click Submit You Will be Contacted Within 24 hours for Approval or Call Now to Speak With a Funding Specialist at 866-792-9366
Fill in the spaces below and click on "apply now".
Business Information
Business Name: *
Website:
Address:
City:
State:
- Please Select -
AK
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AR
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CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
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KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Business Type *
Please Select
Accounting
Aerospace
Architect
Auto / Truck Dealership
Auto Repair/Parts
Bar/Nightclub
Beauty Salon / Spa / Tanning
Bio Tech
Business to Business Services
Child Care
Chiropractor
Computer Hardware/Software
Construction
Consulting
Consumer Products
Couriers/Messengers
Dentist
Distribution
Education Related
Electronics
Energy
Entertainment
Environmental
Financial Services
Fitness
Franchise Other
Funeral Home
Gambling Establishments
Gaming
Gasoline Station
Health Products
Import/Export
Industrial Products / Wholesale
Insurance
Internet/Online Services
Legal Profession
Manufacturing
Media Production
Medical/Healthcare
Natural Resources
Other
Pharmacy
Printing
Publishing
Real Estate Related
Resorts/Hotel/Motel
Restaurant
Restaurant - Franchise
Retail Stores
Security
Service Related
Staffing
Technology/Telecom
Titled Vehicles
Transportation
Veterinarian
Warehousing/Storage
Waste or Recycling
Wine & Liquor Sales
Years in Business
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Phone: *
Fax:
Email: *
Referred By:
Owner/Principle Information
Name: *
Title:
% Ownership:
Home Address:
City:
State:
- Please Select -
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Mobile Phone: *
Email:
Funding Information
What are your total monthly Visa and MasterCard Sales?*
Please Select
$1 - $2,000
$2,001 - $5,000
$5,001 - $10,000
$10,001 - $20,000
$20,001 - $50,000
$50,001 - $100,000
$100,001 - $200,000
above $200,000
What is your business average monthly Gross Revenue?*
Please Select
$1 - $2,000
$2,001 - $5,000
$5,001 - $10,000
$10,001 - $20,000
$20,001 - $50,000
$50,001 - $100,000
$100,001 - $200,000
above $200,000
Enter Advance Amount Requested: $
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which you agree to on behalf of yourself and your business which you are an owner of.