Debt Settlement Application

Tell us about your business

Basic profile to personalize your settlement estimate

Business Name (Legal)

DBA / Trade Name (optional)

Industry

State

Time in Business

Your MCA Debt Snapshot

This is the core data we need to calculate your settlement range

Balances

Total MCA Balance Owed ($)

$

Please enter your total MCA balance

Total Daily/Weekly Payment ($)

$

Positions

Number of Active MCA Positions

1

2

3

4

5+

Payment Details

Payment Frequency

📅 Daily

📅 Weekly

Payment Status

CurrentAll payments on time

Behind1+ payments missed

DefaultedFormal default

CollectionsSent to collections

Last Payment Date

Lawsuits or UCC Freeze?

Yes

No

Your Cash Flow Picture

Helps us calculate how much relief settlement would provide

Monthly Deposits

Average Monthly Bank Deposits

$10K-$25K

$10K - $25K

$25K - $50K

$50K - $100K

$100K - $250K

$500K+

NSF / Insufficient Funds

How often do MCA payments bounce?

Never

Sometimes1-2x/month

Frequent3+/month

Debt Burden

What % of monthly revenue goes to MCA payments?

Under 20%Manageable

20% - 40%Tight

40% - 60%Painful

Over 60%Critical

Revenue Trend

How has revenue trended over the past 3 months?

📈 GrowingUp vs prior period

— FlatRoughly stable

📉 DecliningDown vs prior period

What's your goal?

This helps us match you with the right solution

Primary Goal

💸 Settle my debt Negotiate to pay less than owed and close accounts

⏸ Pause or lower payments Get breathing room while I figure out next steps

🔎 Explore my options Not sure yet - show me what's available

💰 Refinance / consolidate Prefer to pay in full but need better terms

Urgency

How soon do you need a resolution?

🚨 Immediate - I need help now, payments are a crisis

🕒 Within 30 days - Planning ahead but need to move soon

📖 Researching - Gathering info, not urgent yet

Almost done! How do we reach you?

A specialist will call with your full proposal within 24 hours

Your Full Name

Please enter your name

Phone Number

Please enter your phone number

Email Address

Please enter a valid email

Optional

Personal Credit Score Range (helps us find alternatives)

Below 500

500 - 600

600 - 680

680 - 720

720+

Not sure

Did you sign a Personal Guarantee on any MCA?

Yes

No / Not sure

By submitting, you agree to be contacted by a debt specialist. No obligation. 100% confidential.