Capital Access Business Funding Intake

Share the operating details that help route the request.

This form helps ClyrPay review your business profile, funding need, timing, and available documents. Required fields are marked with an asterisk.

Thank you.

Your Capital Access request has been received. A member of our team will review the information and follow up regarding potential funding options.

Please complete the required fields and acknowledge the consent and disclosure before submitting.

Business Information

Legal business name * DBA name Contact name * Email * Phone * Website Street address City State ZIP Industry Years in business Average monthly gross revenue Current payment processor Are you currently a ClyrPay client?

Funding Request

Amount requested * How quickly do you need funding? * Primary use of funds * Preferred funding type Preferred repayment style Open to sales-based repayment? Looking to avoid MCA / revenue-based financing?

Business Profile

Average monthly card volume Average monthly bank deposits Estimated credit score range Do you have existing business debt? Estimated monthly business debt payments Any open tax liens, judgments, or bankruptcies? Do you have customer invoices / receivables? Is this request for equipment? Do you own or rent your business location?

Documents Available

Please select any documents you already have available. You do not need to upload them here unless requested.

3 months bank statements Processing statements Most recent tax return Profit & loss statement Balance sheet Equipment quote Current debt statements Business lease agreement Invoices / AR aging report

Additional Notes

Anything else we should know?

Consent & Disclosure

This form does not affect your credit score and is not a financing approval.