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
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
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
Should be Empty: