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Shield Funding Application2

Supriyanto owns a sole proprietorship called DISTRIBUTOR OF AGRICULTURAL PRODUCTS located in Kedu Temanggung, Central Java, Indonesia that has been in business since 2007. The business distributes agricultural products and had annual gross sales of $1,498,000 last year. Supriyanto is seeking a merchant cash advance for buying and selling agricultural products and provided processing volume and average ticket size information from the last four months ranging from $179,000 to $750,000. Supriyanto authorized Ascendancy Corp to obtain financial records and credit reports to evaluate the application.

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226 views1 page

Shield Funding Application2

Supriyanto owns a sole proprietorship called DISTRIBUTOR OF AGRICULTURAL PRODUCTS located in Kedu Temanggung, Central Java, Indonesia that has been in business since 2007. The business distributes agricultural products and had annual gross sales of $1,498,000 last year. Supriyanto is seeking a merchant cash advance for buying and selling agricultural products and provided processing volume and average ticket size information from the last four months ranging from $179,000 to $750,000. Supriyanto authorized Ascendancy Corp to obtain financial records and credit reports to evaluate the application.

Uploaded by

Operator Rakyat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ID:7039

A. Business Information
Legal Name: supriyanto
DBA: DISTRIBUTOR OF AGRICULTURAL PRODUCTS
Address: Ngebrak Mergowati Suite/Floor: cendrawasih 005
City: Kedu Temanggung State: Central Java Zip: 56252
Phone: +6281235012453 Mobil: 082138118477
Fax: 0620293596013 Email: udinsalim463@gmail.com
Website: meladiadanisha.co.id Federal Tax ID # 81.140.131.4-533.00 State of Inc_____
IND

Legal Entity: Corp: Sole Prop: ✔ LLC: Partnership:


Date Business started: 07/2007 Length of Ownership: OWN Years at Location: 25 # of Locations: KEDU
B. Owner(s) / Principal information
Full name: SUPRIYANTO Full name:
Home Address: rt / rw: 003/004-Ngebrak-Mergowati Home Address:
City: Kedu-Temanggung State: Central Java Zip 56252 City: State: Zip:
SSN: 3323082903770004 % Ownership of Company: 100% SSN: % Ownership of Company:
DOB: 03/29/1977 Home Phone: +6281235013453 DOB: Home Phone:
C. Landlord / Bank / References
Business Location: Rented Owned ✔

Landlord Name: SUPRIYANTO Landlord Phone: 082138118477 Monthly Rent/Mortgage Payment______


Bank Name: Bank BCA INDONESIA Contact: +6281325013453 Phone:
Trade Reference: Distributor Contact: Phone:
Trade Reference: Contact: Phone:
D. Business Profile
List the total VISA/MasterCard processing volumes from the previous four months:
Last Month: Two Months Ago: Three Months Ago: Four Months Ago:
$:___________#Tickets____
750,000 $:___________#Tickets____
426,000 $:___________#Tickets____
225,000 $:___________#Tickets____
179,000
Average Monthly Overall Sales (Checks & Cash)
Do you have any open Cash Advances? Yes ✔ No Have you used a Cash Advance plan before? Yes No ✔
Description of Business: Retail: Restaurant: Lodging: Service: ✔ Home Based: ✔ Automotive: ✔ Other: ✔
Average Ticket Size: 75% Terminal Type: Stages of BCA # of Terminals 1550248260

Type of Product Sold: distributor Using the Money For: Buying and selling of agricultural products
Gross Annual Sales (from previous year tax return): $ 1,498,000
Ascendancy Corp and each of its represent-
atives, 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 therefor (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 con-
sumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, c reditors a nd other third parties. You also authorize
Ascendacy Corp to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for
ation relating to any of you, to Shield Funding
and to each of the Recipients, on its own behalf.

Signature of Owner/Officer #1:_______________________Print Name: ___________________


SUPRIYANTO Date:____________________
7/13/2017

Signature of Owner/Officer #2:_______________________Print Name: ___________________ Date:____________________

Fax application to 866-752-0230 Or Email to sam@shieldfunding.com

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