MiCamp Solutions - Pre Application Form Launch Cart

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COMPANY DETAILS
GENERAL BUSINESS INFORMATION
Business Legal Name (As displayed on tax forms)*
DBA Name*
Federal Tax ID*
Business Website*
Service you offer / What do you sell?*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website URL*
Business Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Type Of Business*
Date Business Established*

MonthDayYear
Date
State of Incorporation/Organization*
PROCESSING DETAILS
Total Monthly Volume Requested*
Average Ticket*
High Ticket*
No, I will only be taking online paymentsMaybe, please call me to discussYes, Please call me to discuss
What number should we call to discuss equipment-
Please enter a valid phone number.Format: (000) 000-0000.
Merchant Statement

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OWNER/SIGNER/OFFICER INFORMATION
Name*

First NameLast Name
Title*
What Is Your Ownership %*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date Of Birth*

MonthDayYear
Date
Drivers license # and State*
D12345678 AZ
Drivers license expiration date *
Social Security Number- *
DEPOSIT ACCOUNT INFORMATION
Bank Name*
Bank Address*
Deposit Account Number*
Routing Number*
Upload your Drivers License or Passport AND a Voided Check or Bank Letter*

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Please complete the information below. A member of our team will reach out to you with in 24 hours

COMPANY DETAILS

GENERAL BUSINESS INFORMATION

PROCESSING DETAILS

OWNER/SIGNER/OFFICER INFORMATION

DEPOSIT ACCOUNT INFORMATION