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Home
Services
Business Cash Advance
Merchant Cash Advance
Reverse Consolidation
Business Line of Credit
How it Works
About us
Apply
Contact Us
Apply Form
Home
Apply Form
BUSINESS INFORMATION
Legal / Corporate Name
DBA
Street Address
*City
*State
Albama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed forces Pacific
*Zip Code
Business Telephone #
Business Fax #
Federal Tax ID
Date Business Started
Length of Ownership
Website
Type of Business(select all that apply):
Retail
MO/TO
Wholesale
Restaurant
Supermarket
Other
Type of Entity:
Sole Proprietorship
Partnership
Corporation
LLC
Other
Email Adress
Product / Service Sold
Est. Monthly Sales
MERCHANT/OWNER INFORMATION
Corporate Officer / Owner Name
Title
Ownership %
Street Address
City
Zip code
*State
Albama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed forces Pacific
SSN
Home #
Cell #
Date of Birth
PARTNER INFORMATION
Make Partner?
BUSINESS PROPERTY INFORMATION
Business Landlord or Mortgage Bank:
Contact Name and/or Account #
Phone #
BUSINESS TRADE REFERENCES (Please list at least 2 trade suppliers.)
Business Name
Contact Name and/or Account #
Phone #
Business Name
Contact Name and/or Account #
Phone #
OTHER INFORMATION
Current Processing Company & Account Number:
Type/Number of Terminals:
Monthly Volume:
Requested Advance Amount/Intended Use:
Requested Daily Withholding:
Prior/Current Cash Advance Company & Length of Time With
Balance
Are there any Federal and/or State taxes passed due?
No
Yes
Has this Company or its Principals ever filed for bankruptcy?
No
Yes
Are there any open Judgement against this company or its Principals?
No
Yes
Is Business Seasonal?
No
Yes
Date
The merchant and its owner(s) or principal(s), (individually, an Applicant”) each represents, acknowledges and agrees as follows:(I) All information and documents provided to Progressive Advance LLC, are true, accurate and complete. (II) Applicant will immediately notify Progressive Advance LLC for any material change in such information or financial condition. (III) Application authorizes Progressive Advance LLC to disclose all information and documents that Progressive Advance LLC may obtain including credit reports and applications to other persons or entitles (collectively, “Assignees” that may be involved with or acquire commercial loans or purchases of future receivables (collectively “Transactions”, and each Assignee is authorized to use such information and documents (and to share such information and documents with other Assignees) in connection with potential Transactions, (IV) Each Assignee will rely upon the accuracy and completeness of such information and documents. (V) Progressive Advance LLC is given “instruction” to obtain information from the Applicant’s personal credit file or other consumer information from Experian, TransUnion or Equifax solely in connection with such application. Progressive Advance LLC and each of their representatives, successors and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary. (VI) Application waives and releases any claims against recipients and any information-providers arising from any apt or omission relating to the requesting, receiving or release of information. (VII) . Applicant provided business cell phone and business e-mail address and hereby consent to the receipt of correspondence/messages regarding the transactions with Progressive Advance LLC and/or its affiliates on either medium. Applicant hereby consent to the receipt of text messages knowing that message and data rates apply. (VIII) Each owner or principal future represents that he or she is authorized to apply for business funding on behalf of the company above.
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