NBDA Draft Signup Form

PayPossible Application for the NBDA Program

Thank you for your interest in participating in the financing program for NBDA, presented by PayPossible. Please note you will need the following documentation to complete the form:
- Color Copy of Owner/Comptroller License
- One of the following documents: EIN Letter / Form SS-4 / Article of Incorporation
- Location Sheet (download later in the form)
- Voided Check(s) / Bank Letter (will need for each entity/location if applicable)
- Merchant Logo (transparent PNG)
Section 1: Business Entity Information

Please carefully complete the entire section below
Legal Business Entity Name:*
Doing Business As (If Applicable):
Business Structure*
EIN Number
SSN
Sole Prop Business Only
Business Email*
example@example.com
Business Phone*
Please enter a valid phone number.
Website (If Applicable):
https://yourwebsite.com
Section 2: Entity Address Information

Please include the official address of the entity as written on your EIN / Articles of Incorpation
Entity Address Information*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section 3: Owner / Comptroller Information

This information will be utilized in our onboarding process, underwriting, and business verification for the platform. If not the owner, the following information will need to be for an executive officer or senior manager (e.g. CEO, CFO, COO, Managing Member, General Partner, President, Vice President, Treasurer etc., or any other individual who regularly performs similar functions.)
Contact Name*

First NameLast Name
Title*
Comptroller Email*
Phone Number*
Please enter a valid phone number.
Owner / Comptroller SSN*
Date of Birth*

MonthDayYear
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section 4: Current Financing Options

Please describe to us what current financing options you have in your store(s)
Does the Business Currently Offer Financing Options?*

YesNo
If yes, please provide the current options offered to their customers.
Gross Annual Sales (last fiscal year)*
Estimated Annual Financing Volume *
If you currently offer financing, please list your current financing volume.
Average Order Value*
Please provide the average ticket size
Years in Business*
Total Number of Years in Business
Do You Accept Refunds?*
How Many Days?

PayPossible Application for the NBDA Program

Section 1: Business Entity Information

Section 2: Entity Address Information

Section 3: Owner / Comptroller Information

Section 4: Current Financing Options

Section 5: Documents

Section 6: Location Sheet Upload