CBD, D8, D9, D10, THCa, Kratom & Tobacco New Account Form
ALL INFORMATION MUST BE PROVIDED EXACTLY AS REQUESTED. PROCESS WILL BE DELAYED UNTIL THIS IS DONE.
How did you hear about us?
*
If a referral, please provide name
Business Legal Name
*
Entity Type
*
Please Select
Sole Prop
LLC
Corporation
Partnership
Legal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal Phone Number
*
Please enter a valid phone number.
EIN letter from IRS
*
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Legal Email Address
*
example@example.com
Business License
*
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Business Information
DBA Name (if applicable)
DBA Address (if applicable)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Articles of Incorporation or Organization (Full Articles must be submitted)
*
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DBA Name
*
Business Start Date
*
-
Month
-
Day
Year
Date
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
*
Please enter a valid phone number.
Business email (if different)
Website
*
Products & Services Sold
*
COAs FOR CBD, D8, D9, D10 CANNOT BE OLDER THAN 12 MONTHS AT ALL TIMES COAs MUST BE ATTACHED TO EACH PRODUCT ON WEBSITE MUST BE .3% THC OR LESS ********************NO EXCEPTIONS*****************
COAs (Certificate of Analysis for CBD, D8, D9, & D10 ONLY-MUST BE FULL PANEL (INCLUDING PESTICIDES AND HEAVY METAL),MUST BE .3% THC OR LESS)
*
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REQUIRED FOR CBD, D8, D9, & D10
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Pictures of Products (Minimum of 6, MUST BE actual pictures taken by you or staff of products) REQUIRED FOR BRICK & MORTAR STORES
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Industry Type
*
Do you sell your products using Brick & Mortar, E-Commerce or both?
*
Please Select
Brick and Mortar
E-Commerce
Both
If e-commerce, what platform is your website build on? **PAYMENT PLATFORM DOES NOT SUPPORT WIX**
*
If not e-commerce, mark with NA
What is your refund policy?
*
REFUND POLICY MUST BE ON WEBSITE
Proof of Domain Ownership - MUST HAVE IF E-COMMERCE**CANNOT USE WIX**
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OWNER INFORMATION
Owner Title
*
Owner Full Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years at Address
*
Owner Cell Phone
*
Email Address
*
Owner Social Security Number
*
Owner Driver's License Number
*
Owner Driver's License State
*
Owner DOB
*
-
Month
-
Day
Year
Date
% Ownership
*
Driver's License Front
*
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Driver's License Back
*
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2ND OWNER INFORMATION
Owner Title
Owner Full Name
Owner Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years at Address
Owner Cell Phone
Owner Social Security #
Email Address
Owner Drivers License Number
Owner Drivers License State
Owner DOB
% Ownership
Drivers License Front
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Drivers License Back
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3RD OWNER INFORMATION
Owner Title
Owner Full Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years at Address
Owner Cell Phone
Email Address
Owner Social Security #
Owner Drivers License #
Owner Drivers License State
Owner DOB
% Ownership
Drivers License Front
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Drivers License Back
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FINANCIAL INFORMATION
Credit & Debit Card Yearly Volume
*
Projected volume if a start-up
Average Ticket Amount
*
Projected volume if a start-up
High Ticket Amount
*
Projected volume if a start-up
Average Monthly Volume
*
Projected volume if a start-up
Max Monthly Volume
*
Projected volume if a start-up
% Swiped in Person at Business
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% of Keyed in Card Transactions
*
If using a payment gateway-Authorize.net, NMI, etc
% E-Commerce
*
Bank Name
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Name on Checking Account
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Checking Account #
*
Check Routing #
*
Voided Check OR Bank Letter
*
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3 months most recent Processing Statements -OR- if a start-up, 3 most recent business or personal bank statements (Full bank statements required)
*
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Do you currently have credit card processing?
*
Please Select
Yes
No
Program Set Up
Type of Processing
EQUIPMENT/OTHER
Do you need a Point of Sale System? If so, how many stations? (Put "NA" if online)
*
Do you need a Standard Terminal? If so, how many stations? (Put "NA" if online)
*
Do you want us to set up auto batch?
Auto Batch Time
Hour Minutes
AM
PM
AM/PM Option
Do you need to be set up to accept tips?
Do you need individualized tips by person?
Special Instructions
***Please know the bank will do a random site inspection for Brick & Mortar locations as part of the final approval.***
ALL banks that process CBD, D8, D10, Cannabis, Hemp & Kratom require this as part of their due dilligence.
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