Obtain Funding Quotes
Please answer a few questions below to obtain funding quotes instantly.
Amount of capital you are looking for:
$
When would you like to obtain funding:
What do you intend to do with the working capital:
Does your business currently have an open advance?
Please select...
Yes
No
Does your business currently have an open advance paid back with a daily or weekly payment out of your business bank account (ACH Advance) or a percentage % of your credit card sales (Merchant Cash Advance)?
First Open Advance Details
How are you repaying this advance?
Fixed daily payment
Fixed weekly payment
Percentage of Credit Card Sales
Other
Lender Name
Approximate Funding Date
Original Funding Amount
$
Payback Amount
$
Approximate Amount Owed
$
Fixed Daily Payment Amount
$
daily
Fixed Weekly Payment Amount
$
weekly
% of Credit Card Sales (Retrieval Rate)
%
Percentage of credit card sales taken daily in order to pay back the advance.
Please Specify Payment Details
How was your experience with this lender?
Are you looking to pay off this advance?
Please select...
Yes
No
Undecided
Does your business currently have a
second
open advance?
Please select...
Yes
No
Does your business currently have an open advance paid back with a daily or weekly payment out of your business bank account (ACH Advance) or a percentage % of your credit card sales (Merchant Cash Advance)?
Second Open Advance Details
How are you repaying this advance?
Fixed daily payment
Fixed weekly payment
Percentage of Credit Card Sales
Other
Lender Name
Approximate Funding Date
Original Funding Amount
$
Payback Amount
$
Approximate Amount Owed
$
Fixed Daily Payment Amount
$
daily
Fixed Weekly Payment Amount
$
weekly
% of Credit Card Sales (Retrieval Rate)
%
Percentage of credit card sales taken daily in order to pay back the advance.
Please Specify Payment Details
How was your experience with this lender?
Are you looking to pay off this advance?
Please select...
Yes
No
Undecided
Does your business currently have a
third
open advance?
Please select...
Yes
No
Does your business currently have an open advance paid back with a daily or weekly payment out of your business bank account (ACH Advance) or a percentage % of your credit card sales (Merchant Cash Advance)?
Third Open Advance Details
How are you repaying this advance?
Fixed daily payment
Fixed weekly payment
Percentage of Credit Card Sales
Other
Lender Name
Approximate Funding Date
Original Funding Amount
$
Payback Amount
$
Approximate Amount Owed
$
Fixed Daily Payment Amount
$
daily
Fixed Weekly Payment Amount
$
weekly
% of Credit Card Sales (Retrieval Rate)
%
Percentage of credit card sales taken daily in order to pay back the advance.
Please Specify Payment Details
How was your experience with this lender?
Are you looking to pay off this advance?
Please select...
Yes
No
Undecided
Does your business currently have a
fourth
open advance?
Please select...
Yes
No
Does your business currently have an open advance paid back with a daily or weekly payment out of your business bank account (ACH Advance) or a percentage % of your credit card sales (Merchant Cash Advance)?
Fourth Open Advance Details
How are you repaying this advance?
Fixed daily payment
Fixed weekly payment
Percentage of Credit Card Sales
Other
Lender Name
Approximate Funding Date
Original Funding Amount
$
Payback Amount
$
Approximate Amount Owed
$
Fixed Daily Payment Amount
$
daily
Fixed Weekly Payment Amount
$
weekly
% of Credit Card Sales (Retrieval Rate)
%
Percentage of credit card sales taken daily in order to pay back the advance.
Please Specify Payment Details
How was your experience with this lender?
Are you looking to pay off this advance?
Please select...
Yes
No
Undecided
Does your business currently have a
fifth
open advance?
Please select...
Yes
No
Does your business currently have an open advance paid back with a daily or weekly payment out of your business bank account (ACH Advance) or a percentage % of your credit card sales (Merchant Cash Advance)?
Fifth Open Advance Details
How are you repaying this advance?
Fixed daily payment
Fixed weekly payment
Percentage of Credit Card Sales
Other
Lender Name
Approximate Funding Date
Original Funding Amount
$
Payback Amount
$
Approximate Amount Owed
$
Fixed Daily Payment Amount
$
daily
Fixed Weekly Payment Amount
$
weekly
% of Credit Card Sales (Retrieval Rate)
%
Percentage of credit card sales taken daily in order to pay back the advance.
Please Specify Payment Details
How was your experience with this lender?
Are you looking to pay off this advance?
Please select...
Yes
No
Undecided
Is your business seasonal?
Please select...
Yes
No
Somewhat
Please check the months that apply
Low Season Months
January
February
March
April
May
June
July
August
September
October
November
December
High Season Months
January
February
March
April
May
June
July
August
September
October
November
December
Does your business have any open state or federal tax liens?
Please select...
Yes - State Liens
Yes - Federal Liens
Yes - Both
None
Approximate Amount Owed
$
Active Payment Plan In Place?
Please select...
Yes
No
How much did your business file in gross sales on its most recent corporate tax return?
$
As filed in your most recent tax return.
What do you project your gross annual sales to be this year?
$
Does your business accept credit cards?
Please select...
Yes
No
Average Monthly Credit Card Sales
$
Would you like to obtain a free, no obligation credit card rate analysis?
Yes
No
We review your credit card rates with your existing processor and send you a comparison sheet. This helps you determine your effective rates for each interchange category and if you are being overcharged.
Would you like to start accepting credit cards and factor a Fixed Percentage (%) of your Credit Card Revenue?
Yes
No
Please select the type of receivables you are looking to factor and obtain funding quotes for:
Gross Sales Deposits
- Repaid through my business bank account with a Daily/Weekly ACH Debit
Credit Card Sales
- Repaid based on a Fixed Percentage (%) of your Credit Card Revenue
Your Contact Information
Salutation
Please select...
Mr.
Mrs.
Ms.
Prof.
Dr.
First Name
Last Name
Business Name (DBA)
Preferred Method of Contact
(Select All That Apply)
Business Phone
Cell Phone
Email
Fax
Text Message
Business Phone #
Cell Phone #
Email Address
Fax #
Please share any other information about your business you think may be relevant:
For assistance, please call
1-866-903-5012 Ext. 304
, or email
support@capitallynk.com
. Thank you.
Internal Use
Yes
No
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