ISO Application

*All fields are mandatory.

Company Information

Owner(s) Information (Total ownership must equal to 100%)


Complete answers Required

If yes, What percentage is from a 3rd party? *

What percentage of deals do you fund vs broker out? *

How much? *

Provide all requested information for ALL reps that will be submitting deals (Any rep not on this list will
not be added to our database and their deals wont be worked):

By signing and faxing or emailing in this application to Merchant Capital Group LLC d/b/a Greenbox
Capital (“Greenbox Capital”) you certify that all information provided in the Application and all other
supporting documents provided to Greenbox Capital is true and complete in all respects and any
dishonesty, incorrect and/or incomplete information will disqualify the Company from consideration for
participation in Greenbox Capital’s ISO Partnership program. You understand and permit Greenbox
Capital, and our agents and assignees, to contact third parties to make all relevant inquiries for the
evaluation of your application, including, without limitation, completing a criminal background check,
requesting business and personal credit bureau reports from credit reporting agencies and other sources,
or for any update, renewal or other lawful purpose. Upon your request, we will advise you if we obtained a
credit report and will give you the credit bureau's name, address, and report.