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Processing Solution Requested
*
In Store - Countertop Credit Card Terminal
Mobile - Mobile Processing App and Swiper
Gateway - Online, Virtual Terminal, Hosted Payment Page, Invoicing
POS - Full POS System for Retail and Restaurant
Quickbooks payments sync requested
*
Yes
No
Business Information
Legal Name
*
Merchant Legal Business Name
DBA Name
*
Merchant DBA Name
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Email
*
example@example.com
Business Phone Number
*
Please enter a valid phone number.
Federal Tax ID
*
Federal Tax ID (Must be 9 digits)
Prior Bankruptcies
*
Yes
No
Date Business Started
*
-
Month
-
Day
Year
Date
Mailing Address (if different than above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Legal Formation (choose one)
*
Sole proprietor
LLC
Corporation
Partnership
Non-Profit (must have 501c documentation)
Business Type
*
Retail (General sales)
Restaurant
Lodging
Service
Internet
Mail Order
Phone Order
Business to Business
Refund/Return Policy
*
No Refund
Refund 30 Days or Less
Exchange
Principle Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
(Must be 9 Digits)
Drivers License Number
Cell Phone Number
*
Please enter a valid cell phone number.
Email
example@example.com
Percentage of Ownership
*
Please type percentage of ownership
Years in Business
*
Please type number of years in business
Bank Information
Bank Name
*
Name of bank for merchant deposit
Routing Number
*
Account Number
*
Processing Information
Projected Annual Sales
*
Monthly Sales Volume (how much will you process each month)
*
High Ticket Request (what is the highest credit card payment we should approve)
*
Average Ticket (what is your average sale amount)
*
Products/Services Sold
*
Notes (please add any special notes here)
Upload Voided Check
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Upload Copy of Drivers License
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