Business Information Retail
LEGAL BUSINESS NAME
DOING BUSINESS AS NAME
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
TYPE OF OWNERSHIP
Sole Prop.
Corporation
LLC
Partnership
Federal Tax ID Number:
EIN
SSN
Business Location:
Store Front
Home
Office
Hours of Operation:
Business Open Date:
Merchant Type
Retail
Restaurant
Utility
Prof. Services
Business to Business
Specific Type of Product(s) Services(s) Sold:
Estimate Monthly Card Volume $:
Average Card Ticket $:
Highest Card Ticket $:
Card present %
Card Not present %
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Owner Information
Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
-
Area Code
Phone Number
Email:
example@example.com
DOB:
Social Security Number:
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Require Documents
Please upload the following information
Voided Check:
Browse Files
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of
Business Licences:
Browse Files
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Owners Driver Licenses or Legal ID
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Other Support Documents (utility bill, business card, advertising)
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Owner Signature
Submit
Should be Empty: