e-Application

Legal Entity Information

Business Entity(Required)

Business Legal Name

DBA Name

State of Incorporation(Required)

Federal ID

Desired Loan Amount

Use of Loan Proceeds

Business Physical Address

Street number

City

State

County

Zip

My Billing Address is different

Billing Address

Street number

City

State

County

Zip

Phone Numbers

Business Phone

Preferred Phone

Fax No.

Business Payments & Questions

Is the Business seasonal?

If Seasonal, What months?

Any Tax Liens?

If Tax Liens, amount due: Personal $

Any Judgments?

If Judgements, amount due: Personal $

LANDLORD/MORTGAGE INFORMATION

Does the Business pay rent?

If yes, Monthly Rent Amount?

Does the Business pay a mortgage?

If yes, Monthly Mortgage Amount?

Landlord or Mortgage Company Name

Name of Landlord

Landlord or Mortgage Company Telephone:

Do you have existing business debt?

If yes, how much do you owe?

List Companies with current balances:

Industry Type: (Business Description)

Gross annual sales from previous tax return or last 12 months total deposits

Are you the original owner?*

If no, when did you take ownership of the business?:

Date business was founded:*

How many owners are there including you ?

OWNERS INFORMATION

1st Owner/ Officer

Owner/ Officer First Name

Owner/ Officer Last Name

Owner/Officer E-mail Address

Driver's License Number

Driver's License State

Social Security Number

Date of Birth

Home Phone

Cell Phone

Street Address

City

State

Zip

2nd Owner/ Officer

Owner/ Officer First Name

Owner/ Officer Last Name

Owner/Officer E-mail Address

Driver's License Number

Driver's License State

Social Security Number

Date of Birth

Home Phone

Cell Phone

Street Address

City

State

Zip

3rd Owner/ Officer

Owner/ Officer First Name

Owner/ Officer Last Name

Owner/Officer E-mail Address

Driver's License Number

Driver's License State

Social Security Number

Date of Birth

Home Phone

Cell Phone

Street Address

City

State

Zip

Agrement

Terms and Conditions(Required)

National Money Man 4 Cash Advance, LLC ("NMM4CA") is the parent company of Money Man
4 Business ("MM4B") and MM4CA ("MM4B", and together with MM4CA, The "Companies").
Each of the Companies provides businesses with certain financial products and/or access to
certain financial products provided by third parties (collectively, the "Financial Products").
Among other things, MM4B provides access to business loans made by affiliates of Industrial
Banks. With respect to the Financial Products, MM4B provides to Industrial Banks, and
NMM4CA provides to the Companies, certain services, including gathering information from
applicants and third parties, including credit bureaus, and transmitting such information to
Industrial Banks and the Companies (collectively, the "Recipients”) as agent on behalf of the
Recipients. By signing below, the above listed business ("Merchant”) and Owner(s)/Officer(s)
(collectively "Applicants") request that each of the Recipients as applicable evaluate whether
Merchant pre-qualifies for the Financial product (s) requested by Merchant, as well as any
other Financial Products provided by any of the Recipients for which the Merchant prequalifies,
Applicants represent that the information contained on this Merchant pre-
Qualification Form and the credit card processor statements and/or bank statements provided
to MM4B and/or any of the Recipients are true and correct, and Applicants will immediately
notify NMM4CA of any financial change in Applicants. Applicants hereby authorize NMM4CA
as agent &/or Consultant on behalf of each of the Recipients (1) to obtain on any of the
Applicants any investigative reports, credit reports (business and personal), statements from
creditors or financial institutions, verification of information provided by any of the Applicants,
or any other information (collectively ''Applicant Information") that the Recipients, or any of
them, deem necessary or desirable in connection with the evaluations and (2) to transmit this
Merchant Pre-Qualification Form, the credit card processor statements, bank statements, other
financial documents and Applicant Information to any and all of the Recipients. Applicants also
hereby authorize each of the Recipients, acting on its own behalf, to take any one or more of
the actions described in part (1) of the immediately preceding sentence. Applicants hereby
authorize the release by any creditor or financial institution of any information relating to any of
the Applicants to NMM4CA, as agent and/or Consultant on behalf of the Recipients, and to
each of the Recipients, on its own behalf. Applicants waive and release any claims against
NMM4CA, all the Recipients, and any creditor, credit bureau or financial institution arising from
any act or omission relating to the obtaining or release of information sought by NMM4CA or
any of the Recipients. Applicants agree that any information communicated by or on behalf of
NMM4CA or any of the Recipients in response or with respect to this Merchant application
Form is confidential and may not be disclosed to third parties (other than to Applicants legal or
financial advisors or as required by law), except at NMM4CA's express, prior written consent
as agent on behalf of one or more of the Recipients. Note Refer to the following websites
Home page to review NMM4CA, LLC privacy policy www.moneyman4business.com or
www.moneyman4cashadvance.com.

By Signing, printing or typing, you are acknowledging & agreeing to our above listed
statement, Information provided by you is True and you give us permission to share your
information & financial statements.

I agree to the terms and conditions.

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