eCASH NOW APPLICATION

Get the Capital You Need To Grow Your Business Today!

Apply Below

Please fill out the application below and a dedicated Account Manager will contact you within 24 hours.

This form is secure and encrypted. Your privacy is important to us and we ensure your information is safe. 

Sign & Complete Application

Applicant authorizes ePaymentAmerica its assigns, agents, bank or financial institutions to obtain and investigative or consumer report from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from applicant.

  • Business
  • Owner
  • Property
  • Sign

Business Information

Legal/Corporate Name

DBA

Physical Address

City

State

Zip Code

Mailing Address (if different from physical address)

City

State

Zip Code

Phone Number

Fax Number

Email Address

Hours of Operation

Website Address

Business Information

Type of Business

Product/Service Sold

Date Business Started

State of Incorporation

Federal Tax ID

Merchant/Owner Information

Corporate Officer/Owner Name

Title

Length of Ownership (Years & Months)

Home Address

City

State

Zip Code

% of Ownership

Date of Birth

Social Security Number

Phone Number

Partner Information (Required if owner has less than 51% ownership)

Corporate Officer/Owner Name

Title

Length of Ownership (Years & Months)

Home Address

City

State

Zip Code

Ownership %

Date of Birth

Social Security Number

Phone Number

Business Property Information

Own/Lease

Time at This Location (Years & Months)

Monthly Rent or Mortgage

Date Lease Ends

Business Landlord or Mortgage Bank

Contact Name and/or Account No.

Office/Mobile Number

Other Information

Current Processing Company

No. of terminals

Average Monthly Credit Card Sales

Average Monthly Total Sales (Cash, Check, & Card)

Requested Advance Amount

Requested Daily Withholding (% of credit card receipts)

Highest Volume Months

Pior/Current Cash Advance Company (if applicable)

Current Balance (if applicable)

Do you usually close the business during part of the year?

If yes, please explain:

Any open State/Federal Tax Liens Against Business or Owner?

If yes, please explain:

Any Lawsuits or Judgments Pending against Business or Owner?

If yes, please explain:

Sign & Date to Complete Application

Applicant's Signature (Please type name)

Today's Date

Co-Signature

Date

a