Application Form
Clearwater Credit Union has partnered with MintPay to offer card processing and point of sale solutions. To find out more information, please complete the questions below.
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Mobile Phone Number
*
Please enter a valid phone number.
Company Information
Please input the physical business address where the cards will be accepted.
Business Name
*
Legal Business Name
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is Business Legal Address different?
Yes
No
Legal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Federal Tax ID
Years in Business
Ownership Type
Partnership
Private Corporation
Public Corporation (owner info exempt)
LLC/LLP
Sole Proprietorship
Government
Non-Profit (will require 501c3)
Briefly Describe your business
*
Principal Information
Please input the information for all individuals with at least 25% ownership stake in the business, as well as the individual (if different) who has the responsibility to control or manage the legal entity (i.e. – CEO, President, Managing Member).
Owner/ Authorized Signer #1
Name
*
First Name
Last Name
Ownership %
SSN#
Date of Birth
Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are there additional owners/signers?
Yes
No
Owner/Authorized Signer #2
Name
First Name
Last Name
Ownership %
SSN#
Date of Birth
Phone Number
Please enter a valid phone number.
Email
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are there additional owners/signers?
Yes
No
Owner/Authorized Signer #3
Name
First Name
Last Name
Ownership %
SSN#
Date of Birth
Phone Number
Please enter a valid phone number.
Email
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Questions
Bank Name
Bank Routing Number
Bank Account Number
Upload Processing Statements
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Current Payment Processing Provider
Processing Monthly Volume
*
Average Transaction Amount
*
POS Equipment
Additional Information
Submit
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