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Business Information

Legal Business Name *

Business Starting Date *

State of Incorporation *

Percentage of Ownership *

EIN / TIN *

Amount Requested *

Business Address *

City *

State *

Zip Code *

How soon do you need the funds? *

Personal Information

First Name *

Last Name *

Email *

Phone Number *

Social Security Number *

Date of Birth *

Sign & Upload Documents

Upload the last 3-4 months of business bank statements

Click or drag files to this area to upload.

You can upload up to 4 files.

Accepted File Types: .png, .gif, .jpg, .doc, .xls, .pdf (Max File Size: 150MB)

Signature *

The undersigned recognizes that their credit history may be a factor in the evaluation of this application of the above named business for funding. The undersigned authorizes "Brex Venture Capital" and partners of "Brex Venture Capital" to obtain their credit report in connection with "Brex Venture Capital " consideration of this application and partners in any subsequent review of the account of the above-named business. The undersigned authorizes "Brex Venture Capital" to utilize information including calls, emails, texts, and mail for marketing efforts from "Brex Venture Capital".

Click The Check Box To Accept and Then Click Submit *

The information provided in this application shall be kept confidential and will not be shared with anyone else.

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