Business & Personal Funding Application
Funding Type
*
Business Funding (Credit Based)
Business Funding (Revenue Based)
Personal Funding (for Myself)
Both Business and Personal
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Contact Method
Phone call
Text message
Email
Any of the above
Preferred Time to Contact You
Morning (9am–12pm)
Afternoon (12pm–5pm)
Evening (5pm–8pm)
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Business Information
Business Legal Name
*
DBA / Trade Name
*
Federal Tax ID (EIN)
Business Entity Type
*
Please Select
Sole Proprietorship
Partnership
LLC
Corporation (C-Corp / S-Corp)
Nonprofit
Other
Industry / Business Type
*
Please Select
Restaurants / Food Services
Retail
E-commerce
Beauty / Salon / Spa
Auto Services
Other
Professional Services
Construction / Trades
Healthcare
If Other Please Specify
Business Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Website
*
Business Ownership Structure
*
Single owner
Two owners
Three or more owners
Time in Business
*
Please Select
Less than 6 months
6–12 months
1–2 years
2–5 years
More than 5 years
Estimated Credit Profile (Primary Owner)
*
Please Select
Excellent (720+)
Good (660–719)
Fair (600–659)
Below 600
Prefer not to say
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Business Revenue & Banking
Existing Business Loans or Advances?
*
No existing loans/advances
Yes – 1 current loan/advance
Yes – multiple current loans/advances
Yes – recently paid off an advance (within last 6 months)
Lender / Provider Name(s)
*
Approximate remaining balance(s)
*
Current daily/weekly/monthly payment amount(s)
*
Business Bank Name
*
How long have you banked here?
*
Please Select
Less than 6 months
6–12 months
1–2 years
More than 2 years
Routing Number
*
Account Number
*
Upload Voided Business Check
*
Browse Files
Drag and drop files here
Choose a file
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Government ID
*
Browse Files
Drag and drop files here
Choose a file
Clear photo/scan of your driver’s license or government-issued ID.
Cancel
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Business Owners / Guarantors
Primary Owner (always required)
Name
*
First Name
Last Name
Title / Role
*
Ownership Percentage
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are there any other owners with 20% or more ownership?
*
Please Select
No
Yes – 1 additional owner
Yes – 2+ additional owners
Additional Owner 1
Name
*
First Name
Last Name
Title / Role
*
Ownership Percentage
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Owner 2
Name
*
First Name
Last Name
Title / Role
*
Ownership Percentage
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Employment and Income
Employment Status
*
Employed (W-2)
Self-employed / Business owner
Contractor / 1099
Unemployed
Retired
Other
Employer / Business Name
*
Job Title / Occupation
*
Employer / Business Phone (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Time with Current Employer / Business
*
Please Select
Less than 6 months
6–12 months
1–2 years
2–5 years
More than 5 years
Social Security Number (SSN)
*
Primary Monthly Gross Income (Before Taxes)
*
Approximate Monthly Net Income (After Taxes)
Optional
Pay Frequency
*
Please Select
Weekly
Every two weeks
Twice per month
Monthly
Other
Next Pay Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
(optional but helpful)
Other Monthly Income
(optional)
Source
(optional)
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Bankruptcy Notice
Any recent bankruptcies, charge-offs, or repossessions?
*
No
Yes
Please Explain
*
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Funding Request
What type(s) of funding are you interested in?
*
Business working capital
Business expansion / growth funding
Personal loan / personal funding
Debt consolidation
Emergency / life event
Other
Amount of Funding Requested
*
Minimum Amount You Would Accept
(optional but helpful)
How soon do you need funds?
*
Please Select
As soon as possible
Within 48 hours
Within 3–7 days
Within 2–4 weeks
Just exploring options
Primary Use of Funds
*
Are you open to daily or weekly payments if required by the program?
*
Yes
No
Maybe – depends on the offer
Anything else we should know about your situation?
(optional)
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Monthly Financial Obligations
Do you own or rent your home?
*
Own
Rent
What is your monthly housing payment?
*
Monthly amount (USD)
Do you own or lease your vehicle?
*
Own
Lease
No vehicle
What is your monthly vehicle payment?
*
Monthly amount (USD)
Upload Supporting Documents
Government ID
*
Browse Files
Drag and drop files here
Choose a file
Clear photo/scan of your driver’s license or government-issued ID.
Cancel
of
Last 3 Months Worth of Business Bank Statements or Last 2 Years of Business Tax Returns
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Credit Report (Temporary Requirement)
To help us pre-qualify you while our soft-pull integration is being set up, please provide your credit report using ONE of the options below. Do not upload login details or passwords. Upload PDFs only.
How would you like to provide your credit report?
Option A: Upload Experian or TransUnion or Equifax PDFs
Option B: Upload a 3-bureau report from MyScoreIQ
If you choose Option B, you can register here and download a 3-bureau report PDF:
www.identityiq.com
Upload Experian or TransUnion or Equifax Report (PDF)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload MyScoreIQ 3-Bureau Report (PDF)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Monthly Financial Obligations
Do you own or rent your home?
*
Own
Rent
What is your monthly housing payment?
*
Monthly amount (USD)
Do you own or lease your vehicle?
*
Own
Lease
No vehicle
What is your monthly vehicle payment?
*
Monthly amount (USD)
Upload Supporting Documents
Government ID
*
Browse Files
Drag and drop files here
Choose a file
Clear photo/scan of your driver’s license or government-issued ID.
Cancel
of
Proof of Income
Browse Files
Drag and drop files here
Choose a file
Upload your last 2–3 pay stubs, or recent tax return/bank statements if self-employed.
Cancel
of
Credit Report (Temporary Requirement)
To help us pre-qualify you while our soft-pull integration is being set up, please provide your credit report using ONE of the options below.Do not upload login details or passwords. Upload PDFs only.
How would you like to provide your credit report?
Option A: Upload Experian or TransUnion or Equifax PDFs
Option B: Upload a 3-bureau report from MyScoreIQ
If you choose Option B, you can register here and download a 3-bureau report PDF:
www.identityiq.com
Upload Experian or TransUnion or Equifax Report
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload MyScoreIQ 3-Bureau Report
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Final Questions
Have you ever declared bankruptcy?
*
No
Yes – currently open
Yes – discharged (within last 7 years)
Yes – discharged (more than 7 years ago)
Please explain further
*
Any outstanding tax liens, judgments, or garnishments?
*
No
Yes
Please explain further
*
Have you ever defaulted on a business loan or personal loan?
*
No
Yes
Please explain further
*
Consent & Acknowledgment
*
I have read and agree to the above authorization, consent, and disclosures. I certify that the information provided in this application is true and correct to the best of my knowledge.
Communication Consent
*
I agree that Thalio Funding and its partners may contact me at the phone number and email address I provided using live agents, automated dialing systems, text messages, and email regarding my application and related offers. I understand that consent is not a condition of approval.
Signed Name (Typed)
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
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