Secure Application

Business funding application

Complete the information below to request business funding. Owner #2 is optional. Your progress can be saved on this device at any time.

Encrypted submission

Your information is secure

Everything you enter — including your Social Security number, tax ID, and banking details — is transmitted over an encrypted connection and stored encrypted in our private, access-controlled system. It is never sold, never shared publicly, and is used only to prequalify your business for funding.

256-bit encrypted transfer

Encrypted, private storage

Never sold or shared

Funding Request

Tell us how much funding you need.

Start with the requested amount, then complete the business and ownership details below.

Funding Request*

Business Information

Business information

Complete the basic details for the business applying for funding.

Legal Business Name*

Doing Business As (DBA)

Company Email*

Business Phone*

Business Structure*

Federal Tax ID*

Average Monthly Deposits*

Do you have a business bank account?*

Business Date Founded*

Business Owned Since*

Business Website

Primary Business Location

Primary business location

Enter the main business address.

Street Address*

City*

State*

Zip Code*

Owner Information

Owner information

Enter the primary owner details.

First Name*

Last Name*

Date of Birth (DOB)*

Social Security Number (SSN)*

Encrypted and stored privately — used only for prequalification.

Percent of Ownership*

Phone*

Home Owner Address*

City*

State*

Zip Code*

Owner #2 Information

Second owner (optional)

Consent

Review and submit

Confirm that the information provided is accurate and that you consent to contact regarding financing options.

By submitting this request, you confirm that the information provided is accurate to the best of your knowledge and you consent to be contacted regarding business financing options.

(C) (1) Certifies that all information and documents submitted in connection with this Prequalification Request are true, correct, and complete; (2) Acknowledges that the owners/principals are personally liable for Merchant; (3) Provides authorization and "written instruction" under the Fair Credit Reporting Act to obtain information from your personal and/or business credit profile as well as additional information from credit bureaus and other sources; and (4) in order for AEE Funding to offer Merchant access to the most complete range of products, authorizes (i) AEE Funding sharing of this Prequalification Request, and all information and documents, with other potential sources of business financing and (ii) such other potential sources of business financing to obtain information from your personal and/or business credit profile as well as additional information from credit bureaus and other sources. This authorization and written instruction are to obtain information solely to conduct a prequalification for business funding, verify provided information and report fraudulent transactions. If you are requesting prequalification on-line, clicking "I AGREE" shall be written instructions with the same effect as your signature.

I agree to the consent and contact language above.*

Authorization

Applicant signature

By signing below, you authorize us to use your information to prequalify you for business funding options.

Owner #1 Signature Name*

Date*

Time

Owner #1 Draw Signature*

Use your mouse or finger to sign.

Submitted over a secure, encrypted connection.