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(305) 384-8391

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Confidential Application: Fields marked with * are required. Your information is protected with military-grade encryption.

Business Information

Legal Business Name *

DBA Name (if different)

Federal Tax ID / EIN *

Business Phone *

Time in Business *

Business Start Date *

Business Type *

Industry *

Business Address *

City *

State *

ZIP Code *

Owner Information

First Name *

Last Name *

Social Security Number *

Your information is encrypted and secure. We never share your personal data. Read our Privacy Policy.

Date of Birth *

Email Address *

Phone Number *

Ownership % *

Home Address *

Financial Information

Average Monthly Revenue *

Personal Credit Score (estimated)

Funding Requirements

Amount Requested *

Use of Funds *

Detailed Purpose of Funding

Supporting Documents (Optional)

Upload Bank Statements: Upload your last 4 months of business bank statements to expedite your application. All documents are optional but recommended for faster processing.

Bank Statement (Month 1) PDF only - Max 10MB

Bank Statement (Month 2) PDF only - Max 10MB

Bank Statement (Month 3) PDF only - Max 10MB

Bank Statement (Month 4) PDF only - Max 10MB

Digital Signature & Authorization

Type your full legal name *

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* I agree to the Terms and Conditions and Privacy Policy, and authorize Merchant Fund Express to verify my information and process my funding application.

* By typing my name above, I agree that this constitutes a legal electronic signature with the same legal effect as a handwritten signature.

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PCI Compliant

A+ Security Rating

Questions? Call us at (305) 384-8391

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