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Business Information

Business Legal Name*

Doing Business As Name

Type of Business Entity*

Business Tax ID

State Of Incorporation

Use of Proceeds

Physical Address*

Street Address City State ZIP Code

Physical Location Phone

Billing Location Phone

Preferred Contact Phone*

Email*

Industry Type*

Physical Location*

Rent

Own

Monthly Rent Amount

Gross Annual Sales*

Business Ownership Date*

If you have questions about the application or would prefer to speak to our account executives, please contact us.

Bank Deposits

Has there been more than 5 days per month where your business bank account ended with a negative balance over the past 3 months?*

Yes

No

How Many Negative Days Over The Past 3 Month*

Please enter a number from 1 to 92.

Deposits Last Month*

Deposits Two Months Ago*

Deposits Three Months Ago*

Deposits Four Months Ago*

If you have questions about the application or would prefer to speak to our account executives, dial 1-877-400-0311.

Visa/MasterCard Processing Volume

Do you accept Visa/MC for payment?*

Yes

No

Monthly Credit Card Sales Last Month

Tickets Last Month

Monthly Credit Card Sales Two Months Ago

Tickets Two Months Ago

Monthly Credit Card Sales Three Months Ago

Tickets Three Months Ago

Monthly Credit Card Sales Four Months Ago

Tickets Four Months Ago

If you have questions about the application or would prefer to speak to our account executives, dial 1-877-400-0311.

Owner(s)/Officer(s) Information

Include Co-Owner Information?

Yes

First Name*

Co-Owner First Name*

Last Name*

Co-Owner Last Name*

Title

Co-Owner Title

Date of Birth*

Co-Owner Date of Birth*

SSN*

Co-Owner SSN*

Home/Cell Phone

Co-Owner Home/Cell Phone

Home Address*

Street Address City State ZIP Code

Co-Owner Home Address*

Street Address City State ZIP Code

Authorizations

By signing below, each of the above listed business and business owner/officer (individually and collectively, "you") authorize ProCap 24/7 ("ProCap") and each of its representatives, successors, assigns and designees ("Recipients") that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivable including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, "transactions") to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. Signers authorize ProCap 24/7 and Recipients to: 1. obtain credit and employment information about the Signers; 2. obtain credit reports and make any inquiries ProCap 24/7 and Recipients consider appropriate in connection with this Application or reviews of the Applicant's account from time to time. You also authorize ProCap to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to ProCap and to each of the Recipients, on its own behalf.

Signature*

Co-Owner Signature*

Date*

Name*

First Last

Co-Owner Name*

First Last

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Comments

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Procap 24/7

Please upload your additional documents* here.

Business Information

Bank Deposits

Visa/MasterCard Processing Volume

Owner(s)/Officer(s) Information

Authorizations

Please upload your **additional documents* here**.