• Name:Email:Website: 
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  • Date Business Started:Length of OwnershipYears at Location:# of Locations:
  • CompanyOriginal Balance:Current Balance: 
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  • CompanyNumber of TerminalsAverage Gross Monthly Sales:Average Ticket Size:Average Visa/MasterCard Monthly Sales:
  • Is Business Seasonal or Closed During Part of the Year:Is Business For Sale:Any Open State or Federal Tax Liens Against Business or Owner:Any Lawsuits or Judgments Pending Against Business or Owner:
  • Drop files here or
    * 3 Months Bank Statements * 3 Months Merchant Statements * Photo ID * Voided Check *Business License ( CA Only )