EIDL APPLICATION CLIENT DATA SHEET
Name:
Personal Address:
Personal Phone Number:
Client SSN:
Company Name:
Business Address:
Business Phone:
Business EIN #:
Business Establishment Date:
Month Day Year
Date
Brief Description of Business Activity:
Gross Revenues for the Prior Year:
Cost of Goods Sold for the Prior Year:
Client DOB:
Client Business Bank Account Account #:
Client Business Bank Account Routing #:
Number of Employees that works for you:
Please send a clear copy of the following:
-Copy of Articles of Organization
-Copy of EIN certificate
-Copy of DL Front and back ( if the address on the license is not correct you must submit an address change card)
-Copy of social security card
-Color Copy of Blank Voided Check or letter from the bank on bank letterhead showing Name, Address and account #, and routing#
-February 2019 or 2020 Bank Statement
EMAIL ALL DOCUMENTS TO: mmogul.pppapplication@gmail.com
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EIDL APPLICATION CLIENT DATA SHEET