Nest Planner Florida application SEAN .pdf

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APPLICATION
Sean McAuliffe
VP of Funding

Ne$t Planner

Cell: (516)282-6576
Fax: (877)654-5123
Sean@Nestplanner.com

Business Legal Name (“Merchant”):

Business DBA Name:

Address, Suite:

Date Business Started:

City, State, Zip:

Federal State Tax #:

Phone:
Mobile:

Fax:

Website:
Legal Entity:

Corp

Merchant Type:

Sole Prop

Retail

Business Location:

LLC

Restaurant

Store Front

Office

Partnership

Service

Products/Services Sold:

Internet

Home

Other

Terminal / POS System (type/quantity):
POS Company Contact Info:

Use of Funds:

Business References
Trade Reference 1:

Name:

Phone:

Landlord/Mortgage
Company Contact:

Name:

Phone:

Trade Reference 2:

Name:

Phone:

Bank Reference:

Name:

Phone:

Trade Reference 3:

Name:

Phone:

Rent/Mortgage
Payment:

Owner/Principle Information
Name:

Name:

Address:

Address:

City, State Zip:

City, State Zip:

Phone:

Phone:

Email:

Email:

% of Ownership:

% of Ownership:

Date of Birth:

Date of Birth:

SSN#:

SSN#:

Funding Information
Average Visa/MasterCard Monthly Sales:

Amount Requested:

Average Monthly Sales:
Have you used a cash advance plan before?:
If ‘Yes’ list previous cash advance provider:

YES

NO
Current balance(s):

By signing below, the Merchant and its owners / principals: (1) certify that all information and documents submitted in connection with this Application is true,
correct and complete; and (2) authorize Nest Planner LLC, agents and assignees or funders to receive credit reports and any other information regarding the
Merchant and its owners and principals from third parties, to verify any information provided on the Application.
By:

Date:_________________ BY:_____________________ Date:

_____

FAX to: (877)654-5123


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