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Pre-Qualification Form

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Full Application
Select One
Does the Merchant have any open MCA or loan accounts(s)?
Business Street Address
Business Street Address
City
State/Province
Zip/Postal
Billing Street Address
Billing Street Address
City
State/Province
Zip/Postal
Business Locations

Owner/Officer 1

Primary Contact
Name
Name
First
Last
Residential Address
Residential Address
City
State/Province
Zip/Postal

Owner/Officer 2

Primary Contact
Name
Name
First
Last
Residential Address
Residential Address
City
State/Province
Zip/Postal

AUTHORIZATIONS - By signing below, each of the above listed business and business owner/officer (individually and collectively, ("you") authorize National Funding Solutions Group​ ("NFSG") each of its representatives, successors, assigns and designees ("Recipients") that may be involved with or acquire commercial financing having daily repayment features or purchases of future receivables including Payment Rights and Purchase Sale transactions, including without limitation the application therefore (collectively, "Transactions") to obtain consumer or personal, business and investigative or credit reports and other Information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize BFE to transmit this application form, along with any of the foregoing Information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to BFE and to each of the Recipients, on its own behalf. Owner(s) and business ("you") understand that if this business credit request is approved, your payment obligations can be made through ACH debits by lender/purchaser or its designee from your bank account. By signing below, you hereby authorize lender/ purchaser or its designee to initiate an ACH test debit from the bank account designated below to confirm that if this credit request is approved, payment processing will proceed as agreed. The test debit will be in a random amount but in no event more than $1.00.