MPFunding-Apply – Laurie Brown

Unsecured Working Capital

For Small Businesses

Within 2-3 Days, Up to $1 Million

A. Business Information

Legal/Corporate Name *

DBA: *

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone *

Fax

Federal Tax ID *

Contact Name *

First

Last

Email *

Website / URL *

Date Business Started *

Length of Ownership *

Years at Location *

# of Locations *

Ownership

Must have at least 67% ownership. If not, add additional owners on additional applications.

Name *

First

Last

Contact Phone Number *

Mobile # *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *

SSN *

% Ownership *

*Must have at least 67% ownership

Veteran Owned? *

Title *

C. Lease

Landlord Information

Landlord name *

Contact *

First

Last

Contact Phone # *

Monthly Rent *

D. Business Profile

Ownership *

Sole proprietorship
Corporation
Partnership
LLC

Merchant type *

Retail
Restaurant
Lodging
Service
Internet
Home-based
Automotive
Other

Cards accepted *

Visa
MasterCard
American Express
Discover

E. Cash Advance

Amount Requested *

We provide up to 2 times the company's gross monthly bank revenue

Average Visa/MasterCard monthly sales *

Average gross monthly sales *

Average ticket size *

Have you used a cash advance plan before? *

If so, what company did you use: *

put NA if not applicable

Original Balance *

put NA if not applicable

Current Balance *

put NA if not applicable

Current payment or daily holdback% *

put NA if not applicable

File Upload - Provide Original Contract

Click or drag a file to this area to upload.

If applicable, attach current cash advance plan original contract

F. Other Information

Current processing company *

put NA if not applicable

File Upload - Items needed for our simple application: 6 months bank statements plus current month to date OR 3 months bank statements plus current month to date and 3 months merchant account statements *

Click or drag files to this area to upload. You can upload up to 99 files.

Attach files

Signature *

By signing above, the Merchant and its owners/principals: (1) certify that all information on and documents submitted in connection with this Application are true, correct, and complete; and (2) authorize M&P, its agents, partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners/principals from third parties, in order to verify any information provided on the Application.

Date of Application *