New Merchant Cash Advance Form

Business Information

Age of Business

Business Ownership Type:

Settlement Account Information

Current and Projections

The current and projected number of checks, dollar amount per checks, and the total dollar amount of all checks are extremely important! Please provide as accurate of information as possible, as the information is used for underwriting criteria.

Number of Checks

Daily Avg:

Daily Max:

Weekly Max:

Monthly Max:

Return Rate

Dollar Amount Per Check:

Minimum:

Average

Maximum:

NSF Return Rate

Total Dollar Amount of Checks

Daily Avg:

Daily Max:

Weekly Max:

Monthly Max:

Recurring Rate

Transaction Method

Location:
Return Policy:
Do you have a refund policy for Visa/MC/Discover/AMEX sales:
If Yes, check one
Are You Currently Processing?:*
Have You Ever Had a Payment Card Processing Relationship Terminated?:*

Thank you for taking your time in filling out the quick application form. Should you have any questions or clarifications, please feel free to contact us.

BalancedProcessing.com
1-800-354-6256
[email protected]
Guaynabo, Puerto Rico