Funding Application

Business Funding Application

Thank you for considering us as a partner in your business growth. We understand the critical role that timely and adequate funding plays in the success of a business. Whether you're starting up, looking to expand, or need a financial boost to overcome challenges, we're here to help.

This application is designed to collect the information we need to assess your eligibility and tailor a funding solution to your business. It covers your personal background, business details, financial position, and specific funding requirements.

Please take your time and provide as much detail as possible. The more accurate the information, the better we can serve you. All information is treated with the highest confidentiality and used solely for the purpose of your funding application.

Let's get started on your path to financial empowerment.

i. Personal Information

Are you a broker? *

Yes

Broker Name

Full Name *

Email *

Phone *

Date of Birth *

Social Security Number *

Mother's Maiden Name *

Address *

City *

State *

Postal Code *

Personal Income * Use commas and decimal points.

Citizenship Status *

Yes, I am a US Citizen

I am a US Non-Citizen

Marital Status *

Married

Single

Are you a veteran?

Yes

What branch?

Race / Ethnicity

Requested Documents

Drop files here or click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

ii. Business Information

Legal Name of Business *

Business Phone *

Business Email

Business Address *

Business City & State *

Business Postal Code *

Business Structure

Date Business Established *

Number of Employees *

Business Industry / Sector *

iii. Financial Information

Annual Revenue * Use commas and decimal points.

Tax ID Number (EIN) *

Monthly Business Expenses *

Personal Credit Score *

Business Credit Score

Collateral Available for the Loan

iv. Funding Details

Purpose of Funding *

Amount of Funding Requested *

Intended Use of Funds *

v. Legal & Compliance

Any Existing Relationships with Financial Institutions *

Yes

Name of Institution

By submitting this application, you affirm that all funds associated with this transaction are derived from lawful activities and that you agree to adhere to all applicable anti-money laundering regulations. You are committed to upholding the highest standards of legal compliance and ethical conduct. As part of this commitment, we reserve the right to conduct due diligence checks to verify the information provided herein. Failure to comply with these regulations and our internal policies may result in the rejection of your application or termination of any funding provided. You also agree to promptly notify us of any changes in the information provided, especially those that might affect compliance with AML regulations. This measure is part of our ongoing effort to prevent illicit activities and ensure the security and integrity of our financial transactions.

I agree to the AML compliance terms above. I affirm the information provided is accurate and that all funds are derived from lawful activities.

I agree to the terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from AXS Capital regarding my application.

All fields marked with * are required.