signature page


Legal Business Name: DBA if Applicable:
Business Address:
City: State: Zip:
Business Phone: Mobile: Company Email:
Tax ID: State of Inc: Date Business Started:
Percentage of Ownership: Social Security: Date of Birth:
Industry or Type of Business: Legal Entity:
First Name: Last Name:
Home Address:
Home City: Home State: Home Zip:

Leave this empty:

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By signing, each of the above listed business and business owner/officer(s) (individually and collectively, "you") authorize Shield Funding and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with, or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (Collectively, “Transactions”) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize Shield Funding to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, any of the information relating to any of you, to Shield Funding and to each of the recipients, on its own behalf.

Signature Certificate
Document name: signature page
lock iconUnique Document ID: af9612ee3716fca6e17da3e3204ee4fe0656cba8
Timestamp Audit
January 24, 2023 4:15 pm ESTsignature page Uploaded by Chris Mathews - [email protected] IP
March 7, 2023 10:27 am ESTotckiller - [email protected] added by Chris Mathews - [email protected] as a CC'd Recipient Ip:
March 7, 2023 10:48 am ESTotckiller - [email protected] added by Chris Mathews - [email protected] as a CC'd Recipient Ip: