DEX Corp Business Funding Application

Fundflo Funding Form

Complete the form below to be considered for funding
Borrower's Information
Primary Contact Name*

First NameLast Name
Primary Contact Email*
example@example.com
Primary Contact Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Contact Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
What kind of funding are you looking for?*
How do you prefer to be reached?*

PhoneEmailTextWeb Portal
What is your Credit Score Range?*

720 or higher680-719620-679600-619580-599580 or belowForeign National, No Score
Is there a Co-borrower?*

YesNo
Co-Borrower's Information
Primary Contact Name

First NameLast Name
Primary Contact Email
example@example.com
Cell Phone Number

Area CodePhone Number
What is your Credit Score Range?

720 or higher680-719620-679600-619580-599580 or belowForeign National, No Score
Business Entity Information
Business Legal Name*
Business trade name or DBA
If applicable
What is the legal structure of your business?*
Which state is your business in?*
How long have you been in business?*
Which industry is your business in?*
Business EIN*
What percentage (%) of the business do you own?*
What is your title at the business?*
CEO, Managing Partner, Director, etc.
Number of employees*
How much funding are you requesting?*
What is the Gross Annual Revenue for the business?*
Briefly describe your business*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*

Area CodePhone Number
Eligibility Questions
Have You Ever Defaulted on a Government Loan? (i.e. SBA Loan, Student Loan, etc.)*

YesNo
Are the majority owners of the business US citizens or Legal Permanent Residents?*

YesNo
Have you exhausted all funding options?*

YesNo
In a paragraph please explain why you need funding. *
How will you using the funds: payroll, rent, inventory, etc.
Identification Verification

for Primary Contact
Thank you for providing responses. By submitting this application, you acknowledge that everything is true and correct to the best of your knowledge. After you select SUBMIT below, your application will be reviewed by a member of our staff. Please note that due to very high volume, there may be some delays, and all applications are reviewed in the order in which they are received. If you have any immediate questions please e-mail us at
darryl@fundflo.co PLEASE SELECT SUBMIT BELOW.
Please verify that you are human*
Should be Empty:

Fundflo Funding Form

Borrower's Information

Co-Borrower's Information

Business Entity Information

Eligibility Questions

Identification Verification