CQS Business Solutions Merchant Cash Advance/ACH Advance Funding Application

Please fill in the spaces below and mail or fax us the application. By doing so, you are giving CQS Business Solutions, as well as its agents and affiliates, permission to review your business and personal credit history in order to provide you with formal approval.

You can email all form data to:

Capital@cqsbusinesssolutions.com

Business Legal Name (“Merchant”):

Business DBA Name:

Address:

City:

Zip:

Suite/Floor:

State:

Phone:

Mobile:

Fax:

Website:

Email:

Legal Entity:

Federal State Tax #:

Merchant Type:

Date Business Started:

Business Location:

Products/Services Sold:

Average Visa/MasterCard Monthly Sales:

Terminal / POS System (type/quantity):

Average Gross Monthly Sales:

POS Company Contact Info:

Average Ticket Size:

Percent of Sales Keyed/ Swiped:

Amex #:

Business References

Trade Reference 1:

Trade Reference 2:

Trade Reference 3:

Owner/Principle Information

Average Visa/MasterCard Monthly Sales:

Amount Requested

Average Monthly Sales:

Have you used a cash advance plan before?:

If ‘Yes’ list previous cash advance provider:

- PLEASE ALSO INCLUDE 4 MONTHS BANK AND CREDIT CARD PROCESSING STATEMENTS WITH YOUR APPLICATION -

By sending in a image of your signature with a copy of your Drivers Licence it acts as effectively signing below, the Merchant and its owners / principals: (1) certify that all information and documents submitted in connection with this Application is true, correct and complete; and (2) authorize In Advance Capital,CQS Business Solutions partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners and principals from third parties, to verify any information provided on the Application.

Upload a copy of your Driver license or State ID here.