Business Loan Application

Employer Identification Number (EIN):		Business Legal Name: *			Business DBA Name:
Type of Business Entity(Check One)
Does the Merchant have any open MCA or loan accounts? Check one			State of Incorporation:		Use of Proceeds:
Physical Street Address: *				City:	State:	Zip Code:
Billing Street Address (If different than above):	Same As Above			City:	State:	Zip Code:
Physical Location Phone #:				Preferred Contact Phone #: *
Industry Type:		RENT OWN	AMOUNT		Current Credit Card Processor
Gross Annual Sales (Previous year’s Tax return):		Under current Ownership Business Start Date:			Average Monthly Credit Card Volume:
List the total VISA MasterCard processing volumes from previous four months:		Last Month:		Two Months Ago:	Three Months Ago	Four Months Ago:
		$		$	$	$

Owner Officer				Primary Contact	Job Title:	Percentage of Ownership:
Last Name: *		First Name: *		SS#:	Date of Birth:	Home Phone:
Home Street Address:			City:		State:	Zip Code:

Authorizations AuthorizationsBy signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize MSS.LLC 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 receivablesincluding Merchant Cash Advance transactions, including without limitation the application therefor (collectively, "Transactions") to obtain consumer or personal, business andinvestigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such asTransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize MSS LLC 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, byany creditor or financial institution, of any information relating to any of you, to MSS LLC and to each of the Recipients, on its own behalf.Owner / Officer's Name: (Print) Date//Owner / Officer's Signature:n relating to the obtaining or release of information sought by MSS LLC .
Owner l Officer’s Name: (Print)
Owner l Officer’s Signature:					Date:
Sales Information (To be completed by Sales Representative)
E-Mail Address: *
E-Mail Address:			Requested working capital amount: $
Pre-qualification Form/ Version 1/02 02 10

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Business Loan Application

Authorizations