Merchant Application

Provide your information and upload files...

Business Information

Business Legal Name

DBA

Tax ID or EIN

Legal Entity

Business Phone

Products Sold

Business Start Date

Website Url

Desired Advance Amount

Purpose of Funds: Please detail the type of business and specifically what the funds are to be used for.

Business Address

Address 1

Address 2

City

State

Zip Code

Ownership Information

First Name

Last Name

Cell Phone

Title

% Ownership

Drivers License State

Address 1

City

State

Zip Code

SSN

Date of Birth

Secondary Owner Information

First Name

Last Name

Cell Phone

Title

% Ownership

Drivers License State

Address 1

City

State

Zip Code

SSN

Date of Birth

Bank Statements

Upload the last 3-6 months of bank statements

Please download the business bank statements from your bank’s online webpage and then drag and drop them below.

Credit Card Statements

Upload the last 3-6 months of credit card statements

Please download the business credit card statements from your processor's online webpage and then drag and drop them below.

Submit Application and Statements

By submitting this form, the Merchant and its Owners/Principals certify that all information and documents submitted in connection with this Application are true, correct and complete to the best of their knowledge. Additionally, authorize Newport Business Capital, Inc. or any of its agents, partners, and affiliates to (1) obtain and use non-business consumer credit reports and any other information regarding the Merchant and its Owners and Principals from third parties, to verify any information provided on the Application; and (2) to obtain the 12 most recent monthly reports detailing Merchant’s credit card processing activity from its card processor or any agent or other third party utilized by that processor to authorize, clear and/or settle credit card payments.

If you have an issue with this form please contact galaxyofstarshelp@newportbc.com