Mom & Pop Business Funding - ISO Partner Portal

A. Business Information

Legal / Corporate Name *

DBA (Doing Business As)

Physical Address

City

State

Zip

Business Phone

Fax

Federal Tax ID (EIN)

Contact Name

Website

Date Business Started

Length of Ownership

Years at This Location

Number of Locations

B. Ownership(Must have at least 67% ownership)

Owner Name

Contact Phone Number

Home Address

City

State

Zip

Date of Birth

SSN (Last 4 digits)

% Ownership

Title

C. Lease — Landlord Information

Landlord Name

Landlord Contact

Monthly Rent

Landlord Phone

F. Cash Advance

Amount Requested (up to 2× gross monthly revenue)

Have you used a cash advance before?

Avg Visa/MasterCard Monthly Sales

If yes, which company?

Avg Gross Monthly Sales

Original Balance

Avg Ticket Size

Current Balance

Current Payment / Daily Holdback %

G. Other Information

Current Processing Company

Additional Information

H. Authorization & Signature

By submitting this application, the Merchant and its owners/principals certify that all information on and documents submitted in connection with this Application are true, correct, and complete; and authorize Mom & Pop Business Funding, its agents, partners, and lenders to receive credit reports and any other information regarding the Merchant and its owners/principals from third parties, in order to verify any information provided on the Application.

I agree to the authorization statement above and certify that all information provided is accurate and complete.

After submitting, Meddi Piya will review your application and contact you promptly. No obligation — no upfront fees.

Questions? Call (210) 792-0343

Business Funding Application