Request Term Sheet Contact Us If you are human, leave this field blank. Name First Last Last Business Address City State Zip Phone Fax Email Website Subject Federal Tax ID Business Start Date Under Current Ownership State of Incorporation Last 4 months bank deposits: Gross Annual Sales (from previous year tax return): Products/Services Sold: Type of Entity Incorporated S-Corporation Limited Liability Corporation Sole-Proprietor How many negative balance days have you had over the past 4 months? Last 4 months Visa/MC volume & ticket count: Have you recently filled for bankruptcy? Yes No If yes, when? Do you have any open merchant cash advance or business loan accounts? Yes No If yes, what is your Prior/Current Cash Advance Company: Current Balance: MERCHANT/OWNER INFORMATION Corporate Officer/Owner Name: Title: Ownership %: Home Address City State Zip Code SSN: Date of Birth: Home Phone Cell Phone PARTNER INFORMATION Partner Name: Title: Ownership %: Home Address: City State Zip Code SSN: Date of Birth: Cell Phone: BUSINESS PROPERTY INFORMATION Business location rented or mortgage: Business location monthly rent or mortgage payment: Business Landlord or Business Mortgage Bank: Contact Name and/or Account #: Phone Business Name1: Contact Name and/or Account #: Phone: Business Name2: Contact Name and/or Account #: Phone Business Name3: Contact Name and/or Account #: Phone Upload your last four months bank and/or credit card statements below Website/URL Paragraph By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) authorize YAFI - You Asked For It! (“YAFI”) and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, “Transactions”) to obtain consumer or personal, business and investigative 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 YAFI 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 YAFI and to each of the Recipients, on its own behalf. reCAPTCHA Submit
