Sharing the Credit Online Application v2

MERCHANT INFORMATION FORM
Business Information
Business LEGAL Name*
Taxpayer Number (EIN or SSN)*
Email Address (Required)*
Business DBA (If different)
Business Legal Address*
DBA Address (If different)
City, State, ZIP*
DBA City, State, ZIP (if different)
Contact Name*
Business Phone Number*
How Did You Hear About Us?*
More Info

Signer Information (Signing Authority must be 25% or higher)
Signer Name*
Social Security #*
Driver's License # & State*
Signing Authority/Ownership %*
Mobile Number (Required)*
Home Phone Number
Date of Birth*

MonthDayYear
Address
Signer Address*

Home Address

Street Address Line 2

City, State, ZIPState / Province

Postal / Zip Code
Years at Current Address

Business Profile
Type of Ownership*
State of Incorporation*
Type of Business*
Type of Goods and/or Services Sold*
Business/Merchant Website Address

Processing Information
Average Sales Ticket*
High Sales (Maximum) Ticket*
Monthly Volume*
Swiped / Keyed Percentage (100%)*
Swiped %: Keyed %*
Are you currently processing?*
Current Point of Sale/Processing Equipment
If yes, with whom?
Home based business?

Merchant Banking Information
Bank Name*
Bank Routing / Transit Number*
Checking DDA / Account Number*
Types of Payment Accepted or Required (check all that apply)

CHECK/ACHCREDIT/DEBIT CHECK CARDPin-DEBIT (Card Present Only)

Charity Supported Information
Charity Name
Charity Website
Charity Phone Number
PROVIDE THE FOLLOWING DOCUMENTS WITH THIS FORM:

1. Signer’s Driver’s License 3. Current Processing Statements (3 Months) 4. Proof of Business (EIN Paperwork, Corp. Paperwork) NOTE: Application Processing and/or Underwriting may ask for more documentation. They will reach out to the merchant directly for the documents.
Should be Empty: