New Application

Company Information

ie: Automotive, Finance, Entertainment, etc.
The state/region where your business is registered
Year of registration

Owner Information



The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Claremont Advance, Inc. (hereinafter CAI) including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify CAI of any change in such information or financial condition, (3) Applicant authorizes CAI to disclose all information and documents that CAI may obtain including credit reports to other persons or entities (collectively, “Assignees”) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, “Transactions”) and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) each Assignee will rely upon the accuracy and completeness of such information and documents, (5) CAI, Assignees, and each of their representatives, successors, assigns and designees (collectively, “Recipients”) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release of information, and (7) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.


Feel Free to Contact Us Anytime. • 212.972.2233 • Qualify@ClaremontAdvance.com
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