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TERM LOAN REQUIRED DOCUMENTS
MERHCANT CASH
Merchant Services
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BUSINESS NAME
BUSINESS DBA:
STATE OF INCORPORATION:
(Required)
BUSINESS START DATE /MONTH
BUSINESS START DATE/YEAR
Tax EIN Number
(Required)
Business Entity Type (pick one):
(Required)
Corp.
LLC
LLP
Part.
Sole Prop.
Other
BUSINESS PHONE NUMBER:
(Required)
CELL PHONE NUMBER:
(Required)
WEB ADDRESS:
BUSINESS EMAIL:
(Required)
TYPE OF INDUSTRY
(Required)
AUTO
BAR
CLEANERS
CLOTHING
DAY CARE
DELICATESSEN
DENTIST
DOCTOR OFFICE
FLORIST
GARDEN CENTER
GROCERY STORE
GYM
HAIR &NAIL SALON
LIQUOR
HOTEL MOTEL
MARTIAL ARTS
NIGHT CLUB
OPTICAL OUTLET
PET STORE
RESTAURANT
TANNING
OTHER
(Industry Type if other) Please describe
BUSINESS STREET ADDRESS:
(Required)
CITY:
STATE:
ZIP CODE:
BILLING ADDRESS (if differnet than above)
city:
STATE:
ZIP CODE
Rented/Mortgaged/Monthly Payment
Rented
Mortgaged
MONTHLY PAYMENT:
LANDLORD NAME:
LANDLORD PHONE:
COMPANY ANNUAL SALES:
(Required)
MONTHLY CREDIT CARD VOLUME:
Do you have any open MCA or Loan Accounts?
Yes
No
LENDER 1:
BALANCE 1
LENDER 2:
BALANCE2:
Open judgments or tax liens?
(Required)
Yes
No
Open/discharged bankruptcies?
(Required)
Yes
No
FIRST NAME/PRIMARY OWNER/OFFICER
LAST NAME
SS#
(Required)
DATE OF BIRTH:
(Required)
HOME PHONE:
CELL PHONE NUMBER:
(Required)
HOME ADDRESS:
(Required)
CITY:
STATE:
ZIP CODE
FIRST NAME/SECONDARY OWNER/OFFICER (if required)
LAST NAME:
SS#
DATE OF BIRTH:
Untitled
HOME PHONE:
CELL PHONE:
HOME ADDRESS:
CITY:
STATE:
ZIP CODE:
USE OF FUNDS:
(Required)
DESIRED LOAN AMOUNT:
(Required)
SELECT YOUR LOAN BROKER:
CLICK HERE
BRUCE PIAZZA
MICHAEL PIAZZA
PATRICK SACCOR
JOE THOMAS
ROGER GULLEY
JIM LOOMIS
GLENN JUDEBETH
FRED SHATZOFF
FRAN NEMORIN
TERRY MONDO
ADD YOUR LOAN BROKERS NAME
Terms and condition
terms and conditions
(Required)
By signing below, each of the above listed business and business owner/officer (individually and collectively, “you” authorize PAYLO CAPITAL and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, “Transactions”) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize PAYLO CAPITAL to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to PAYLO CAPITAL and to each of the Recipients, on its own behalf
(Required)
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Business Documents
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