Merchants Cash Partners Online Application

Name*

First Name

Last Name

Email*

Phone*

Source Company

Rep

Business Information

Legal Business Name*

Doing Business As*

Business Address*

Address Line 1

City

State

ZIP Code

Business Start Date*

Business EIN (Tax ID)*

What is your entity type?*

Owner Information

Home Address*

Address Line 1

City

State

ZIP Code

Date Of Birth*

Cell Phone Number*

Ownership %*

Owner 2 Ownership %

Social Security*

Owner 2 Information

Owner 2 Name*

First Name

Last Name

2nd Owners Email*

2nd Owners Date of Birth*

2nd Owners Social Security*

2nd Owners Cell Phone Number*

Is the Address the same as the 1st owner?

2nd Owners Address

Address Line 1

Address Line 2

City

State

ZIP Code

Signature Required

Thank you for your interest in Merchants Cash Partners.

When you submit this application, please check your email for the completed document to E-SIGN.

Thank you!

Disclosure

Applicant authorizes Agent its assignees, agents, banks or financial institutions to obtain an investigative report from credit bureaus or credit agencies, and also to investigate the Trade References, Landlord and any other references provided on this Application or any other documents submitted by Applicant and Applicant’s named Officer or Owner for the purposes of obtaining funding.

Merchants Cash Partners Online Application

Business Information

Owner Information

Owner 2 Information

Signature Required

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