:: Professional Merchant Advance Capital, LLC ::

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Basic Qualification Requirements:

Business must process an average of $10,000/month for at least 4 past months

Business must have good daily transaction volume, and low ticket size

Business must have at least 1 year left on current lease

Business and owner cannot have any open bankruptcies, judgments or liens

NOTE: Fields marked with an asterisk (*) are required fields.

^*Company Name:	*
^*Contact Name:	*
^*Contact Title:	*
^*Address 1:	*
Address 2:
^*City:	*
^*State:	*
^*Zip Code:	**
^*Phone Number 1:	** Ext: *
Phone Number 2:	* Ext: *
Fax Number:	*
Best time to contact you:
^*E-mail Address:	**
^*Operating Since:	* *[mm/yyyy]
^*Date Business Started :	* *[mm/yyyy]
^*Length of Ownership :	*
^*Average no. of daily transactions:	*
^*Average Ticket :	*
^*Type of Business:	*
^*Monthly Visa/MC Sales:
^*How did you hear about us?	*
If you have already spoken with a sales representative, please enter his/her name:

Additional Comments: