Merchant Cash Advance Application

Use the form below to apply. It's free and there are no obligations.
    In addition please provide:
  • Past 12 months of credit card statements
  • Past 3 months of bank statements
  • A copy of your driver's license(s)
  • A voided business check.
Receive an offer within 24 hours, funds within 5 to 7 business days.
You can also Click here to Download the Application then Print and Fax the form to 516-977-2611

Call Us if you have any questions 888-221-4545

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5 minute Application Form

Fields marked with * are required

Merchant Information
Type of Entity Corporation Partnership Sole Proprietorship Other
* Entity Name: Business DBA Name:
* Address: Suite/Floor:
* City: * State:
* Zip: * Phone:
Mobile: Fax:
Website : * Email :
Fed. ID #: Business start date
* Responsible Party: Title:
State of Incorporation: Current Ownership:
* Product Sold: Use of proceeds:
Principal #1
* Full Name: Title:
% of Ownership: * SSN#:
* Address : * City:
* State: * Zip:
Home Phone: Fax:
* Email : * Mobile:
Drivers License #: Drivers License State:
Principal #2
Full Name: Title:
% of Ownership: SSN#:
Address : City:
State: Zip:
Home Phone: Fax:
Email : Mobile:
Drivers License #: Drivers License State:
Trade References - Name 3 companies that can vouch for a good pay history.
Company: Contact Name: Phone #:
Company: Contact Name: Phone #:
Company: Contact Name: Phone #:
Property Information
Building Type Free Standing Mall Home Based Shopping Center Office Other
Own or Lease? Own Lease
Monthly Rent or Mortgage: $ Lease Start Date:
Landlord / Mortgage Holder: Time Remaining on Lease:
Contact Name: Fax or Email:
Address: City:
State: Zip:
Phone:
Banking Information - Additionally please provide a voided business check.
Bank Name: Bank Account # :
Contact Name: Routing # (9 digits):
Branch City: Branch Zip:
Bank Phone # :
Additional Information
Hours of Operation:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
open: close: open: close: open: close: open: close: open: close: open: close: open: close:
Months of Operation, Check all that apply: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
* Describe use of funds:
* How much money do you want? $
Have you ever filed for bankruptcy protection? Are you contemplating Filing Brankruptcy, Reorganization, or an assignment for the benefit of creditors? If so please explain:
Are you current with your rent or mortgage? Are you current with all Payroll, State and Federal Sales tax, etc.? If not please explain::
Please provide the name and phone number of your payroll company, accountant, or other party who is resposible for paying your payroll taxes:: Contact Name: Contact Phone # :
Are there any pending, threatened, or recently filed claims, judgements, tax, liens, or UCC filings against the merchant or guarantor? If so please explain:
Please list all credit card terminals or POS systems being used at this time:
American Express Account Number(s):
Insurance broker / agent::
Is there any outstanding balance with any other cash advance or funding company?:
12 Months of credit card statements
PDF files only:
3 Months of bank statements
PDF files only:
Copy of your driver's license(s)
PDF or JPG file:
Voided Business Check
PDF or JPG file:
Authorize
* I hearby certify that all of the information set forth is true and accurate. I authorize BankCard Funding, it's assigns, and its agents to obtain an investigative report from credit bureaus or credit agencies, and also to investigate the vendor references and any other references given on this application or on any other documents submitted by applicant for the purpose of obtaining funding.

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Call Us if you have any questions 888-221-4545

BankCard Funding is not a bank or lending institution and it does not make loans. It simply purchases future credit card receivables at a discounted rate. Therefore, there is no interest rate, no collateral, and no set time frame for the payback.