Monday – Friday 9:00 – 17:00
(201) 669-4222

    Legal/Corporate Name

    DBA

    Physical Address

    City

    State

    Zip

    Telephone

    Fax

    Federal Tax ID

    Date Business Started

    Length of Ownership

    Website

    E-mail Address

    Type of Entity (circle one)

    Sole PropiertorshipPartnershipCorporationLLCOther

    Type of Business (circle all that apply)

    RetailMO/TOWholesaleRestaurantSupermarketOther

    Product/Service Sold

    MERCHANT/OWNER INFORMATION

    Corporate Officer/Owner Name

    Title

    Ownership %

    Home address

    City

    State

    Zip

    SSN

    Date of Birth

    Home

    Cell

    PARTNER INFORMATION

    Partner Name

    Title

    Ownership %

    Home address

    City

    State

    Zip

    SSN

    Date of Birth

    Home

    Cell

    BUSINESS PROPERTY INFORMATION

    Business Landlord or Business Mortgage Bank

    Contact Name and/or Account

    Phone

    BUSINESS TRADE REFERENCES

    (Please list at least 3 trade suppliers. Please attach any additional references on a separate page.)

    Business Name

    Contact Name and/or Account

    Phone

    Business Name

    Contact Name and/or Account

    Phone

    Business Name

    Contact Name and/or Account

    Phone

    Business Name

    Contact Name and/or Account

    Phone

    Processing Company

    Number of Terminals

    Terminal Type

    Requested Advance Amount

    Requested Daily Withholding

    Monthly Volume

    Prior/Current Cash Advance Company (if applicable)

    Balance

    Applicant authorizes Yellowstone Capital its assigns, agents, banks or financial institutions to obtain an investigative or consumer report
    from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from applicant.


    Contact By Email

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    Contact By Phone

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    Come To See Us

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