New ACCOUNT Registration Form
Customer Details:
Organization Name
*
Type of Business
*
Corporation
LLC
Sole Proprietor
Other
If "Other", explain
*
Parent Company (if applicable):
Tax ID#
*
Organization Street Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Phone Number
*
Organization Website
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Primary Contact (First/Last Name)
*
First Name
Last Name
Primary Contact E-mail
*
example@example.com
Primary Contact Phone Number:
*
Please enter a valid phone number.
Primary Contact Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Next
AP Contact (First/Last Name)
*
First Name
Last Name
AP Telephone Number
*
Please enter a valid phone number.
AP Contact Email Address
*
example@example.com
Email address where invoices need to be sent
*
example@example.com
AP Mailing Address
*
Street Address
PO Box
City
State / Province
Postal / Zip Code
AP Fax Number
Please enter a valid phone number.
Please provide an image file of the company or brand logo that you'd like to use on the card and messaging. If you don't have the file at this time, you may email it to support@iqpay.com.
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