COMPANY INFORMATION
Legal Name of Business
Legal Address
Street Address
Street Address Line 2
City
State
Zip Code
DBA Name
DBA Address (If different)
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
-
Area Code
Phone Number
Fed Tax ID
How long
Type of Corporation
LLC
Individual
Partnership
Corporation - S or C
Web Address
Business E-Mail Address
Support E-Mail Address
OWNERSHIP INFORMATION
Name
First Name
Last Name
Email
Date of Birth
-
Month
-
Day
Year
SSN
DL #:
Address
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
-
Area Code
Phone Number
% of Ownership
Title
EQUIPMENT INFORMATION
Terminal / POS needed
Number of Terminals needed
SITE INSPECTION
Detailed Explanation of Type of Merchandise, Products, or Services Sold
ATTACHMENTS TO BE SUBMITTED WITH THIS APPLICATION
VOIDED CHECK – Text Picture ok
Browse Files
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of
DRIVERS LICENSE – Text Picture ok
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of
PREVIOUS PROCESSING STATEMENTS IF CURRENTLY PROCESSING (3 months if requested)
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of
BANK STATEMENTS (3 MONTHS IF REQUESTED)
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of
ARTICLES OF INCORPORATION (IF REQUESTED)
Browse Files
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of
Miscellaneous
Terminal
IP
WiFi / Password
Dial
Retail / Rest
Own/Lease
Square Ft
Zoning
Commericial
Industrial
Residental
Building Type
Office
Separate Building
Shoping Center
Residental
Any additional Information
John Richards - 877.858.3350 - John@MBcard.com
Admin Email
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