Merchant Application Form - Bretton Capital

Legal Business Name

DBA

Entity Type

Fed Tax ID

Business Address

City

State

Zip Code

Industry

Business Phone #

Business Email

Length of Ownership

Owner First Name

Owner Last Name

Owner Address

City

State

Zip Code

Owner DOB

Owner Cell #

Owner Email

% of Ownership

Annual Revenue ($)

Do you have an AR?

Amount ($)

Do you accept CC?

Funding Amount Requested ($)

Current MCA Balance(s)?

Use of Funds

Print Name

Signature

Date

Please submit the last 4 months of business checking account statements to submissions@brettoncap.com.