Business Information
Any private data or personal information submitted across our platform is encrypted at all times
Corporate / Legal Name
*
DBA Name
*
Ownership Type
*
Please Select
Individual
Partnership
Corporation
Government
LLC
Non-profit
Publicly Traded
Legal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your DBA (Doing Business As) information same as Corporate/Legal?
*
Yes
No
Business Location (if different than legal address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Federal Tax ID / EIN
*
When was your business founded?
*
-
Month
-
Day
Year
Date
Where do you prefer to receive mail?
*
DBA
Legal
Building Type
Shopping Center
Office Building
Industrial Building
Residence
Area Zoned
Commercial
Industrial
Residential
Square Footage
0-500
501-2500
2501-5000
5001-10000
10,000+
Website Address
*
Ownership Information
Please list all principals who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, own 25% or more of the equity interests of the legal entity listed in this application.
Owner Name
*
First Name
Last Name
Title
*
Please Select
CEO
Chairman
Co-Owner
Controller
Director
General Manager
Office Manager
Owner
Partner
President
Treasurer
Vice President
Driver's License State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver's License Number
Any private data or personal information submitted across our platform is encrypted at all times
Driver's Expiration
-
Month
-
Day
Year
Date
Social Security Number
*
Any private data or personal information submitted across our platform is encrypted at all times
Date of Birth
*
-
Month
-
Day
Year
Date
Address & Contact Information
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Ownership %
*
Is this the individual listed on the articles of incorporation?
*
Yes
No
Have you or ownership within your company ever filed for bankruptcy?
*
Business Bankruptcy
Personal Bankruptcy
Never
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Processing Information
This section pertains to information about your business’s credit card processing and acceptance.
Bank Account Number
*
*The account provided will be used for deposits and deductions of fees unless otherwise requested changed
Bank Routing Number
*
All Bank Routing number will have nine digits
Does this business currently accept credit cards?
*
Yes
No
Monthly Volume
*
Average Transaction Amount
*
Max Transaction Amount
*
Describe your product/service.
*
Which payments would you like to accept?
*
VISA, MASTERCARD, DISCOVER, AMERICAN EXPRESS®
PIN Debit
EBT
Primary Sales Method
*
In-person (card present)
Mail/Phone (card not present)
Internet/eCommerce (card not present)
Percentage of Sales from International Customers
Please describe your refund and return policy.
*
Please list equipment and/or software used to process cards (point-of-sale, terminal, payment gateway, etc.)
Inventory Maintained
On-Site
Off-Site (i.e. Warehouse)
3rd Party Fulfillment Center
Service Only (No Products Sold)
Are there any other companies involved in shipping or fulfilling product/service (i.e. fulfillment center)?
*
Yes
No
Are there any other companies involved in shipping or fulfilling product/service (i.e. fulfillment center)?
*
Yes
No
Do you offer recurring and time-extended services (subscriptions, memberships, recurring plans, etc.)?
*
Yes
No
Notes (Optional)
Signature
*
How did you hear about Boston Payments
Please Select
Individual Referral
Website
Google Ads, other
Social Media
Other
If Individual referral please provide name
First Name
Last Name
Submit
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