Shield Funding Loan Application

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Legal Business Name

DBA

Address

City

State

Zip

Phone

Mobile

Tax ID

State of Inc

Website

Legal Entity

Corp Sole Prop LLC Partnership

Date Business Started

Length of Ownership

Years at Location

Number of Locations

First Name

Last Name

Home Address

Home City

Home State

Home Zip

Social Security

Percentage of Ownership

Total Average Monthly Sales

Any Open Cash Advances

Yes No

Have You Used a Cash Advance Before

Yes No

Signature