Merchant Cash Advance Application

Business Information

Company Name *

DBA

Business Inception Date *

Company Type *

Nature of Business

Business Address *

Business Address - Line 2

City *

State *

Business Phone *

Zip code *

Email *

Business Fax

Next > Business Financial Information

Tax ID *

Annual Revenue *

Average Bank Balance *

Do You Accept Credit Cards? *

Yes No

Average Credit Card Volume

Desired Amount

Use of Funds

LL/Mortg Holder Name

LL/Mortg Holder Phone

Name of Current Funder, if Applicable

Est. Balance $

Owner's Email *

Owner's First and Last Name *

Home Address *

Home Address - Line 2

City *

State *

Home Phone

Zip Code *

Social Security Number *

Cell Phone

Date of Birth *

Percent Ownership *

Credit Score Estimate

Annual Income *

Add Second Owner

Owner 2 Information

Owner's Email *

Owner's First and Last Name *

Home Address 1 *

Home Address - Line 2

City *

State *

Home Phone

Zip Code *

Social Security Number *

Cell Phone

Date of Birth *

Percent Ownership *

Credit Score Estimate

Annual Income *

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Coastal Capital Group

Merchant Cash Advance Application

Business Information

Next > Business Financial Information

Next > Owner 1 Information

Owner 2 Information