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Business Funding Application
Please fill out the form carefully to apply for funding for your business. We will contact you via the supplied contact information on this form.
Name

First NameLast Name
Company Name
Email
example@example.com
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alt. Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Business Start Date

MonthDayYear
Minimum 1 Year to qualify
Monthly Revenue
Must be at 10k or higher to qualify
Company Ownership %
Your stake in ownership
Industry
Company DBA
Business Name if not operating w/ DBA
State of Incorporation
Business Entity Type
S Corp, C Corp, LLC, etc.
Business Website
Leave blank if none

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Address & Home Address the same?
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

MonthDayYear
mm/dd/yyyy
Social Security Number
e.g. 123-45-6789
Federal Tax ID (EIN)
e.g. 98-7654321
Do you have any open MCA or Loan accounts?
Open MCA or Loan Account Details
Lender & current balance owed separated by commas (e.g. - Lender A 20k, Lender B 10k)
Bank PDF Files Upload

4 Months of statements (4 files minimum)
Cancelof
Signature
By signing below, each of the above listed business and business owners/officers/members (individually and collectively, “you”) authorize Flexibility Capital, LLC (“FC”) and each of its representatives, successors, assignees, affiliates and designees (collectively “Recipients”) that may be involved with theacquiring of commercial loans and/or other products that have daily repayment features for the purchase of future receivables, including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, “Transactions”) to obtain consumer or personal business and investigative reports and other information about you, including without limitation credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize FC to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes; however, FC shall not disclose information in your credit report to third parties. You also consent to the release, by any credit or financial institution, of any information relating to you, to FC and to each of the Recipients, on its own behalf.
It's okay for my loan specialist to send me text message. I can opt out at anytime.
Application Date

MonthDayYear
Date
sender_name
full_package_notification_email
source
utm_campaign
utm_source
utm_medium
utm_term
utm_content
gclid
tracking_code
inquiry_form_id
Should be Empty:

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