New Customer Registration Form

Shift Business Funding Application
Business Information
Amount Requested*
Use of Funds*
Business Legal Name*
DBA Different then Legal Name?
DBA Name
Tax ID Number*
Business Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Business Website
Company Type*
State of Incorporation
Start Date

MonthDayYear
Date
Industry Type
Annual Revenue
Business Address

Street Address

Street Address Line 2

CityState

Zip Code
Current Business Advances/Loans?

Owner Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Social Security Number*
SSN
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Additional Owner?*
Ownership %*
Ownership Percentage
Owner Information
Additional Owner Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date Of Birth

MonthDayYear
Date
Social Security Number*
SSN
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Ownership %*
Ownership Percentage
Please upload last 4 months bank statements

Cancelof
Signature

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