Merchant Application Form
Please Name Your Sales Associate
COMPANY INFORMATION
Legal Name of Business
*
Merchant DBA
*
DBA Address (Street, City, State, Zip)
*
Telephone Number of Business
*
Legal Address (if Different from DBA Address)
*
Total Months in Business (or New)
*
Federal Tax ID EIN
*
Website
OWNER INFORMATION
Full Name (First, Middle, & Last)
*
Date of Birth (DD/MM/YY)
*
/
Month
/
Day
Year
Date
Residential Address Street City State Zip
*
SSN
*
Owner Cell Number
*
Email
*
example@example.com
OWNERSHIP TYPE
Please select the ownership type:
*
Sole Proprietorship
Public Corporation
Private Corporation
Limited Liability Coproration
Non Profit
TRANSACTION INFO
Yearly Sales Volume
*
Highest Ticket
*
Average Ticket
*
Transaction Type
*
Please Select
Card Present
Card Not Present
Text to Pay
BUSINESS TYPE
Business Type
*
Retail
Delivery
E-Commerce
Industry Type
*
(Example: Dispensary or Smoke Shop)
Products Sold
*
PROCESSING FEES
Rate %
*
6.95% Min
% Fee To Customer
*
% Customer will pay of fee
% Fee To Merchant
*
% Merchant will pay of fee:
REQUIRED DOCUMENTS
Articles of Incorporation
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
EIN Letter/Number
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Government Issued Photo ID
*
Browse Files
Drag and drop files here
Choose a file
(ID, DL, Passport)
Cancel
of
Voided Check
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Business/Cannabis License
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Recent Statements - The Last 3 Months
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
I have submitted all required docs
*
Yes
AUTHORIZED SIGNER
Title of Signer
*
Date
*
/
Month
/
Day
Year
Date
Signature
*
Submit
Should be Empty: