High Risk Pre-Application Checklist
Complete each field & attach the valid supporting documentation on Page 3.
Business Information
Legal Business Name
*
(Include LLC or INC) and DBA
Business Physical Address
*
Years in Business
*
EIN/Federal Tax or VAT #
*
Owner Cell#
Please enter a valid phone number.
Format: (000) 000-0000.
Main Business Customer Service #
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Owner/Signer Full Name
*
Main Business Email (for customers)
*
example@example.com
Business Website/URL
*
Country Incorporated
*
Business Type (Products / Services Sold
*
Transactions Processed Face-to-Face (%)
*
Transactions Processed MOTO/eCommerce (%)
*
Anticipated average sale amount
*
Anticipated highest sale amount
*
Anticipated monthly sales volume
*
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Signer Information
Legal First & Last Name
*
Ownership %
*
Title
*
Social Security Number [OPTIONAL]
Date Of Birth
*
/
Month
/
Day
Year
Date
Current Home Address
*
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02. Color Copy Of Signer's Driver's License
*
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03. 3 Months' Most Recent Bank Statement
*
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04. Articles of INC/Organization
*
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05. 3 Months' Most Recent Processing Statement
*
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