t: (646) 375 3360

e-mail: info@nationwidecapitalsolution.com

Application

MCA Application

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Company Information

Business Premises Information

Physical Address
Address Line 1
Apartment/Suite #
City
State/Province
Zip/Postal
Country
Business Home Based
Business Property Ownership

Funding Request

Legal & Financial Disclosures

Has Any Owner Been Convicted of a Felony?
Any Existing Cash Advances?

Current Advances

Business Financial Information

Card Transactions Overview

Bank Statements

Owner / Officer Information

Address
Address Line 1
Apartment/suite #
City
State/Province
Zip/Postal
Country

By signing below, each of the above-listed businesses and business owners/officers (individually and collectively, “you”) authorize Nationwide Capital Solutions, LLC, acting in its capacity as an Independent Sales Organization (“ISO”), to share, transmit, and disclose the information you provide—in this application and in any supporting documents—to its representatives, successors, assigns, lenders, funders, underwriters, and other third-party partners (collectively, “Recipients”) for the purpose of evaluating and facilitating commercial financing transactions, including Merchant Cash Advances, Term Loans, Lines of Credit, SBA transactions, and any related products (collectively, “Transactions”). – Nationwide Capital Solutions, LLC (the ISO) may share your application, supporting documents, bank statements, credit card processor statements, and any other information that you have voluntarily provided. – The ISO’s role is limited to submitting and transmitting information to the Recipients for evaluation. – This authorization permits any Recipient to obtain consumer credit reports, personal credit reports, business credit reports, or investigative reports on its own behalf based on this authorization. – This authorization solely permits the ISO to share the information you provide with the Recipients for the purpose of underwriting, evaluating, and processing your request for financing. You also authorize Nationwide Capital Solutions, LLC, as the ISO, to share your information with Recipients and any other Recipients involved in evaluating or funding your Transaction.