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
Month & Year Business Began
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
Title
Email
Date of Birth
-
Month
-
Day
Year
SSN
Drivers License #
Driver License State Issued
Drivers License Issue & Expire Dates
Address
Street Address
Street Address Line 2
City
State
Zip Code
Cell Phone Number
-
Area Code
Phone Number
% of Ownership (Need Owner info on all owners over 25%)
Credit Card Processing Info
Monthly Volume
Average Ticket
Occasional High Ticket
Card Present & Swiped Percentage
Mail Order / Phone Order Percentage
Internet Percentage
Detailed Explanation of Merchandise/Product/Service Sold
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
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PREVIOUS PROCESSING STATEMENTS IF CURRENTLY PROCESSING
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DRIVERS LICENSE – Text Picture ok
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Pictures of Terminals, hardware, POS, printers, cash drawers etc...Including serial numbers
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Miscellaneous
Terminal
IP
WiFi / Password
Dial
Retail / Rest
Own/Lease
Square Ft
Zoning
Commericial
Industrial
Residental
Building Type
Office
Separate Building
Shoping Center
Residental
Building/Office Sq/Ft
Any additional Information
Paul Mulhern - 855.630.4944 - Paul@MBcard.com
Admin Email
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