Advance Credit Funding Corporation

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Referred By:

Vendor: *

Contact Name: *

Phone: *

Email: *

Equipment or Service Cost: *

Customer Information:

First Name: *
Last Name: *
Business Name: *
Industry Type: *
Phone Number: *
FAX: *
Cell Number:
Email: *
Street: *
City: *
State: *
ZIP: *
How long has your business been open?*
How much does your business process per month in credit cards (Visa/MC/AMEX/Debit)?*
How much in checks? *
Does business currently have and outstanding merchant cash advance? If so, what is the name of the company? *