e-Application Legal Entity InformationBusiness Entity(Required)Please SelectCorporationNonprofitLimited Liability CompanyPartnershipLimited PartnershipLimited Liability PartnershipSole ProprietorBusiness Legal Name DBA Name State of Incorporation(Required) Federal ID Desired Loan Amount Use of Loan Proceeds Business Physical AddressStreet number City State County Zip My Billing Address is different Billing AddressStreet number City State County Zip Phone NumbersBusiness PhonePreferred PhoneFax No.Business Payments & QuestionsIs the Business seasonal?YesNoIf Seasonal, What months? Any Tax Liens?YesNoIf Tax Liens, amount due: Personal $ Any Judgments?YesNoIf Judgements, amount due: Personal $ LANDLORD/MORTGAGE INFORMATIONDoes the Business pay rent?YesNoIf yes, Monthly Rent Amount? Does the Business pay a mortgage?YesNoIf yes, Monthly Mortgage Amount? Landlord or Mortgage Company Name Name of Landlord Landlord or Mortgage Company Telephone:Do you have existing business debt?YesNoIf 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?*YesNoIf no, when did you take ownership of the business?: MM slash DD slash YYYY Date business was founded:* MM slash DD slash YYYY How many owners are there including you ?I am the solo owner2 owners3 ownersOWNERS INFORMATION1st Owner/ OfficerOwner/ Officer First Name Owner/ Officer Last Name Owner/Officer E-mail Address Driver's License Number Driver's License StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificSocial Security Number Date of Birth MM slash DD slash YYYY Home PhoneCell PhoneStreet Address City State Zip2nd Owner/ OfficerOwner/ Officer First Name Owner/ Officer Last Name Owner/Officer E-mail Address Driver's License Number Driver's License StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificSocial Security Number Date of Birth MM slash DD slash YYYY Home PhoneCell PhoneStreet Address City State Zip3rd Owner/ OfficerOwner/ Officer First Name Owner/ Officer Last Name Owner/Officer E-mail Address Driver's License Number Driver's License StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificSocial Security Number Date of Birth MM slash DD slash YYYY Home PhoneCell PhoneStreet Address City State ZipAgrementTerms 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.UntitledHiddenUnique ID