Legal Business Name
*
DBA Business Name
*
EIN Number - Federal Tax ID:
*
Business opened - registered date with IRS
-
Month
-
Day
Year
Date
Owner Contact information
*
First Name
Last Name
Owner Home address :
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Of Birth
/
Month
/
Day
Year
Date
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Owner SSN Number
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Type
*
Sole Proprietorship
LLC
Partnership
Corporation
Other
Type of Business :
*
Tobacco Shop
Grocery/Supermarket
Beauty Salons and Spas
Restaurants & Food Vendors
Auto Shop / Body shop
Cars Dealers
Healthcare and Wellness Providers( Medical - Vet - suppliers )
Hotels
Online & E-Commerce Shops
Nonprofits & Religious Institutions
Contractors & Home Service Pros
ATM
Rewards Loyalty Program
Other
Business and Credit Info
Business E-mail
*
example@example.com
Business Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Physical Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business closing time :
*
Hour Minutes
AM
PM
AM/PM Option
Average Ticket Amount
*
Average Monthly Credit Card Sales
*
Select the best apply to you.
Normal processing - Credit card processing with Side Terminal ( No Cash register )
Normal processing - Credit card processing with Cash register
Cash Discount / Dual Pricing - (Customers pay the transaction fees) Side terminal.
Cash Discount / Dual Pricing - (Customers pay the transaction fees) With Cash Register.
Clover
SumUP POS - Restaurant Recommended
Loyalty Rewards Program - Great for Smoke Shops
NRS POS
Valor
Dejavoo
File Upload - Voided Check or Bank statement
*
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Driver license
*
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EIN Number ( Federal Tax ID )
*
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EBT Letter ( FNS Number )
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Any other documents
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Name of the person you working with : (Sales Rep Name)
Current Company you dealing with :
The last 3 Months of the Credit card statements:
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Agreement
(By checking and sign these boxes you are agreeing to our terms - should you have any questions please contact us)
Agreement and Terms
Merchant Services Agreement is entered into by and between Ultra Quick pay / Minnesota Investors Group LLC ,and the undersigned business. This Agreement establishes the terms under which Company provides payment processing and related services to Merchant.1. Term of Agreement. This Agreement shall remain in full force one year from the date of execution. Thereafter, it shall automatically renew on a one-year basis unless terminated by Company. Company reserves sole discretion regarding termination and may terminate this Agreement with or without cause.2. Authorization for ACH Debits Merchant authorizes Company to initiate ACH debits from the Merchant’s designated bank account on file to collect all fees, charges, balances, and obligations due under this Agreement, including but not limited to: service fees, equipment, compliance fees, chargebacks, penalties, legal expenses, and any other amounts owed.3. Services Provided Company agrees to provide Merchant with payment processing, point-of-sale (POS) solutions, equipment leasing, ACH services, compliance tools, support, and related merchant services.4. Company Rights & Policies Company retains the right to modify terms, adjust pricing, withhold funds to cover losses, enforce termination fees, and require reserves or security deposits.5. Merchant Responsibilities Merchant must maintain sufficient funds, comply with laws, follow PCI DSS standards, update business information, remain liable for disputes, and display all required compliance signage.6. Chargebacks, Returns, & Fees Merchant is responsible for all chargebacks and disputes. Company may debit Merchant’s account for such amounts without notice. A returned item fee of $35 applies per occurrence.7. Confidentiality & Data Security Both parties agree to maintain confidentiality of business and customer data. Merchant must comply with NACHA and PCI DSS requirements.8. Indemnification & Liability Merchant agrees to indemnify and hold Company harmless from all claims, damages, or liabilities arising from Merchant’s operations or breach of this Agreement.9. Termination & Early Termination Fee Merchant may not terminate during the initial five-year term without penalty. Early termination results in a fee of $500or the remaining monthly fees due, whichever is greater.10. Dispute Resolution All disputes shall be resolved first by good-faith negotiation, then by binding arbitration in Hennepin County,Minnesota.11. Assignment Merchant may not assign this Agreement without Company’s written consent. Company may assign its rights and obligations at any time.12. Amendment Company reserves the right to amend this Agreement with written notice. Continued use of services constitutesacceptance.13. Personal Guaranty The individual(s) signing this Agreement also personally and unconditionally guarantee all obligations under thisAgreement.14. Governing Law This Agreement shall be governed by the laws of the State of Minnesota.
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