Merchant Information Form

Merchant Information Form

Business Information
Legal Business Name
DBA Name
Business Website
Business E-mail
Business Phone Number
Format: (000) 000-0000.
Date Business Started

MonthDayYear
EIN Tax ID
Business Type
Physical Business Address

Street Address

CityState

Zip Code
Legal Mailing Address (If Different)

Street Address

CityState

Zip Code
Payment Processing Information
Services / Products Sold
Refund Policy
Monthly Total Sales Volume
Average Per Sale Amount
Highest Per Sale Amount
Banking Information
Bank Name
Routing #
Account #
Voided Business Check or Bank Letter

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Owner Information
Full Name

First NameLast Name
Email
Phone Number
Format: (000) 000-0000.
SSN
DOB

MonthDayYear
Copy of Driver's License

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Should be Empty: