Pure Capital Funding Application

Please fill in the spaces below and mail or fax us the application. By doing so, you are giving Total Merchant Resources, as well as its agents and affiliates, permission to review your business and personal credit history in order to provide you with formal approval.

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Business References

Trade Reference 1:

Trade Reference 2:

Trade Reference 3:

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Miscellaneous Information
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Owner/Principal Information

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2nd Owner/Principal Information
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By signing below, the Merchant and its owners / principals: (1) certify that all information and documents submitted in connection with this Application are true, correct and complete; and (2) authorize Pure Capital, its partners, funders, and lenders to receive 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.

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Business bank statements

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Merchant processing statements

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