Funding Application | Dent Funding

1 Business Information

Legal Business Name *

DBA (if applicable)

Business Type *

Industry *

Date Established *

Federal Tax ID (EIN) *

Number of Employees

Business Address *

City *

State *

ZIP Code *

Business Phone *

Business Website

2 Owner / Personal Information

First Name *

Last Name *

Ownership % *

Date of Birth *

Social Security Number * Used for identity verification only

Home Address *

City *

State *

ZIP Code *

Personal Email *

Mobile Phone *

3 Financial Information

Average Monthly Revenue *

Outstanding Business Debt

Any Active Loans or Advances? *

Approximate Credit Score *

Any Bankruptcies in last 2 years?

Any Tax Liens?

4 Funding Request

Funding Amount Requested *

Funding Type Needed *

How will you use the funds? *

How soon do you need funding?

Additional Comments

5 Authorization & Signature

By submitting this application, you authorize Dent Funding to verify the information provided and contact you regarding funding options. You understand that this application does not constitute a loan agreement and that all funding is subject to underwriting approval.

I certify that all information provided in this application is true and accurate to the best of my knowledge.

I authorize Dent Funding to contact me via phone, email, or text regarding this application and funding options.

I have read and agree to the Privacy Policy and Terms of Service.

Full Name (Electronic Signature) *

Date *

🔒 Securely submitted · No hard credit pull · Response within minutes

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Application Received!

Thank you for applying with Dent Funding. A dedicated funding advisor will contact you immediately to discuss your options. Please have your 3 most recent business bank statements ready.

Questions? Call us at (561) 800-1273 or email submissions@dentfunding.com

Business Funding Application

Application Received!