Merchant Cash Advance Application

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General Business Information

Principals

One

Two

Merchant Information

Credit Card/Terminal Information

Vendor References

Are you presently leasing your business space

Banking Information

Merchant Questionnaire

Has any principal of the business been bankrupt? Is any principal contemplating filing for bankruptcy or any other insolvency proceedings? If so explain.

Are there any pending, threatened or recently filed claims, judgements, tax liens, against the business/merchant or any of the principals? If so please specify.

Are you current with your rent or mortgage payments for your business? If not, please explain your current status.

What are the daily hours of operation of your business? What days of the week are you open?

Do you currently have an outstanding advance from another financier, funding company or bank (including a credit line or overdraft)? If not, have you ever had an advance from another merchant funding company?

Information Disclosure Letter

I/We grant our irrevocable permission to release our confidential information to Money on Tap. I/We understand this information is being used for their credit underwriting purpose only. Permission is also granted to contact any business past, present or future we may deal with including Banks and Landlords we currently use or will use in the future. Each person signing below consents to Money on Tap obtaining credit, financial and related personal or business information (including a credit information report) about the undersigned from any credit bureau or credit reporting agency in connection with this application, and consents to the collection, use and disclosure of personal information as further described in the Privacy Policy in the next section.

The above signed hereby certifies that all of the information set forth is true and accurate.

Support Documentation

Please provide ALL of the following materials to ensure your application is accepted

Business Bank Account Void Cheque

Last 6 months of your Merchant Processing Statements (front pages only)

Most recent Business Bank Statement(all pages)

Articles of Incorporation or Business Registration

Business Lease

Personal Information

Front and back copy of Government Issued ID ex: Driver's License or Passport (for all Principals)

Proof of home address ex: utility bill

Privacy Policy

Collection, Use and Disclosure of Information. In this form the term "personal information" means information about an identifiable individual, as more particularly described by applicable Canadian federal and provincial privacy legislation. You consent to our collection, use and disclosure of your business and personal information as described below and form the following purposes:

We may, from time to time, use your credit, financial and related personal information provided in this application or collected or compiled by use in connection with this application, any Merchant Agreement entered into with us by the business named above (the "Business"), any guarantee you provide in connection with any such agreement and any resulting business or other credit agreements or guarantees between us an you or the Business, and any update, renewal or extension of same (collectively, the "Services") for the purposes of (1) verifying and evaluating your current and ongoing creditworthiness and the creditworthiness of the Business, you eligibility and the eligibility of the Business or the Services and other information provided to us in connection with Services, (2) establishing, administering, servicing, collecting and enforcing the Services, (3) registering and enforcing security on or with respect to the Services and (4) generally providing the products and services you and the business have requested, Birth Dates, Social Insurance numbers or other personal identification, if provided, may be used by us for the purpose of verifying your identity, including matching records or credit information. For the above purposes and for providing credit information to your potential creditors and potential creditors of the Business and to establish your credit history and the credit history of the Business, we may, from time to time, disclose credit, financial and related personal information to, and collect such information from (i) our respective affiliates, agents and representative; (ii) credit bureaus and reporting agencies, and (iii) other lenders, businesses and financial institutions with whom you or the Business have had or may not have a financial relationship, including references you have provided in support of the Services and any credit card processor you or the Business may deal with; and may exchange such information between us and such other parties for such purposes. You consent to the disclosure of such information by these third parties to us. Relevant business and personal information my be disclosed to card associations as necessary to process, authorize and authenticate transactions and in order to comply with regulations of the card associations. We may use business and personal information and disclose such information including you date of birth and relevant account information to third parties, as necessary to register security interests, including as contemplated in any Merchant Agreement, for the purposes of enforcing such security or otherwise in connection with collection of amounts owing to us; for the purposes of detecting and preventing fraud; and complying with money laundering, terrorist financing or similar laws in Canada and foreign countries (including the United States), including checking your identity against watch lists established by regulatory agencies or similar bodies in Canada or foreign countries. We may use your business and personal information and disclose such information to parties connected with or involved in the purposed or actual financing insuring securitization sale, assignment or other disposal of all or part of our respective business or assets (including for example, your (or the Business) agreements, accounts or amounts owing to us) for the purposes relating to the evaluation and/or performance of these transactions. Successors and assignees of our business or assets may collect, use and disclose your (or the Business) business personal information as processing and security requirements. We may otherwise collect, use and disclose personal information as described in the Merchant Agreement and as further descried in our ("Privacy Principles") publication. We may otherwise collect, use and disclose personal information as permitted or required by law. This consent will be valid for so long as required to fulfill the purposes described above. You represent and warrant that you have the necessary consent of any other principals, guarantors or other individuals whose personal information is provided to us in connection with application for the purposes described above. Authorized employees and agents of Money on Tap that require access to your personal information will have access to your file.

For further information about Money on Tap privacy practices, you may call or contact us.