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$40 per hour

Remote work from home

A. Ownership / Applicant Information

Owner's Full Name *

Your Title

Email *

Cell Phone *

Owner's Home Address *

City *

State *

Postal code *

Date of birth *

Social Security Number

Estimated Personal Credit Score? *

Below 620

620 - 699

Above 700

B. Business Information

Legal / Corporate Name *

DBA *

Business Address *

Business Phone Number *

Website

Federal Tax ID (EIN) *

Date Business Began *

Length of Current Ownership *

Year at Current Location *

C. Lease and Landlord Information

Landlord's Name *

Landlord's Phone Number *

Monthly Rent ($) *

D. Business Profile

Ownership / Incorporation Type *

Sole Proprietor
Corporation
Partnership
LLC
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Merchant Type *

Retail
Restaurant
Lodging
Service
Internet
Home-Based
Automotive
Other
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Payment Methods Accepted *

Visa
MasterCard
American Express
Discover
PayPal
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Average total gross monthly revenue? *

Business Owned Collateral You Are Willing to Use to Secure a Loan (check all that apply)

Accounts Receivable (Money owed to your business by your B2B customers/Outstanding invoices)

Business Owner's 401k

Commercial Real Estate (Revenue Generating)

E. Cash Advance Information

How soon are you looking to deploy the funds *

1 to 2 weeks
2 to 4 weeks
1 month or more
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What do you need the money for? *

How much are you looking to borrow? *

Have you used a cash advance plan before? *

Yes
No
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If 'Yes', what was the Original Balance?

What is the Current Balance?

F. Other Information (Please add any information that might assist us in processing your request. Submit the application along with 6-months most recent bank statements.)

Please share any additional information that might be important in helping me support your in building your business.

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By clicking "Apply Now", the Merchant and its owners/principals (1) certify that all the information on the Application and any documents submitted in connection with this Application are true, correct and complete; and (2) authorize CCS Wealth, its agents, partners and lenders to receive credit reports and any other information regarding the Merchant and its owners/principals from third parties as required to verify any information provided in the Application.