This document contains a merchant application form for Decimal Factor Inc. It requests information such as the business's legal name, physical address, date started, ownership details, bank information, credit card processing details, and trade references. The applicant agrees to Decimal Factor obtaining a consumer report and investigating the application details. It collects information on two business principals including their names, roles, contact details, social security numbers, and residence histories.

1. Decimal Factor, Inc. Administrative Form
Merchant Information
Type of Entity (check one)_corporation_limited liability company_partnership_limited partnership_limited liability partnership_sole proprietorship
Merchants Legal Name: D/B/A: Federal ID
Physical Address: City, State Zip: Use of Proceeds
State of Incorporation/Organization Specific Type of Date business started (mm/yy) Length of Ownership Requested Amount
Business
Position: Phone(area code + number): Fax (area code + number):
E-mail address:
Website address : Describe Specific Types of Product/Service Sold :
Principal No. 1 Percentage (100%)of Ownership
Name: Social Security Number:
Date of Birth: Position OWNER Home Phone: Cell Phone:
Residence Address City, State Zip How long at home address? How long at Previous address?
Principal No. 2 Percentage (______%)of Ownership
Name: Social Security Number:
Date of Birth: Position OWNER Home Phone: Cell Phone:
Residence Address City, State Zip How long at home address? How long at Previous address?
Trade References
Company: Contact Name: Phone Number:
Company:
Contact Name: Phone Number:
Company: Contact Name: Phone Number:
Is your business for sale? Have you ever filed for bankruptcy? Have you had a previous cash advance? If YES, How much
current balance left to be paid?
Own Lease: Time Remaining
Landlord/Mortgage Company: Contact Name: Phone Number:
on the lease:
Bank Information
Bank name: Phone Number: Address: City : State: Zip:
Transit # (ABA Routing): Account #: Personel Bank:
Visa / MasterCard Information
Yearly Gross Sales (Including cash, Monthly Visa/Mastercard
Average Ticket : Annual Visa/MC Sales:
check, and all credit cards) : Average:
Merchant #
Current Processor Name: Time with current Processor: Terminal Type: # of CC Terminals:
Workingcapital4U is a marketing division of Decimal Factor Inc. Applicant authorizes Decimal Factor Inc. its assigns, agents, bank
or financial institutions to obtainan investigative or Consumer report from a credit bureau or a credit agency and to investigate
thereferences given on any other statement or data obtained from applicant. .
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Applicant’s Si
’ Signature A li
Applicant’s N
’ Name D
Date