MCA Disclosure Template

1. Parties & effective date

Legal name of the funder, legal name of the merchant (including d/b/a if any), and the effective date of the advance.

2. Amount financed

The exact dollar amount deposited into the merchant's account after all origination fees, wire fees, and third-party charges are deducted. This is the net amount the merchant actually receives.

3. Total payback amount

The gross dollar amount the merchant will repay, expressed as principal × factor rate in dollars — not as a multiplier alone.

4. Factor rate

The multiplier applied to the amount financed (e.g., 1.40). The template shows factor rate alongside — not instead of — an estimated APR.

5. Estimated APR

An annualized percentage rate, calculated using the stated payment schedule and disclosed fees. Regulated states require this calculation; this template treats it as mandatory regardless of state.

6. Payment schedule

• Payment frequency (daily, weekly, monthly)
• Payment amount (fixed dollar figure or holdback percentage)
• First payment date and expected final payment date
• Business-day vs. calendar-day treatment

7. Fees & charges

Every fee, itemized and in dollars: origination fee, ACH/wire fee, underwriting fee, servicing fee, NSF/bounce fee, blocked-payment fee, early-termination fee, and any other charge the merchant may incur over the life of the advance.

8. Prepayment terms

Whether the merchant can prepay, and if so, whether prepayment reduces the total payback. Many MCAs require the full factored payback even if the merchant repays on day one — this field forces that term into the open.

9. Reconciliation rights

A statement of the merchant's right to request a true-up of the holdback percentage against actual receivables, including how to request reconciliation and the funder's response timeline.

10. Collection & default terms

Events of default, cure period (if any), and a plain-language summary of the funder's remedies — including whether the contract contains a confession of judgment, personal guarantee, or UCC filing.

11. Stacking & renewal

Whether the contract restricts the merchant from taking additional advances, and the terms under which the funder offers renewals or refinances (including how existing balances are rolled in).

12. Contact & complaint channels

Funder's licensed representative, regulatory registration numbers where applicable, and the state agency or attorney general the merchant can contact with complaints.

Signature block

Merchant acknowledgment that the disclosure was received before signing the underlying agreement — dated and countersigned by the funder.