Application Questions To Be Filled Out & Returned
Business Information
Legal Name
*
(Include LLC or INC) and DBA
Business Address
*
Years in Business
*
EIN/Federal Tax ID Number
*
Best Customer Service Number
*
Please enter a valid phone number.
Best Contact Full Name
*
Best Business Email (for customers)
*
example@example.com
Website/URL For Your Business
*
Parameters
Anticipated average sale amount
*
Anticipated highest sale amount
*
Anticipated monthly volume in
*
Signer Information
Legal First & Last Name
*
Title & Ownership %
*
Social Security Number
*
Date Of Birth
*
/
Month
/
Day
Year
Date
Driver's License Number
*
Driver's License Expiration Date
*
/
Month
/
Day
Year
Date
Driver's License State
*
Please Select
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Residential Address
*
Signer Information
Bank Name
*
Routing Number
*
Account Number
*
Back
Next
01. Check Or Bank Letter
*
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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. COAs For Each Product
*
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must be on the site as well
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06. Proof of Domain Ownership
*
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screenshot showing URL & owner
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07. Product Sheet Required
*
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08. 3 Months' Most Recent Processing Statement
*
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