Application Form
Nombre / Legal Name
*
Ownership Type Tipo de organización
*
Please Select
Individual
Partnership
Corporation
Government
LLC
Non-profit
Publicly Traded
Legal Address DIRRECION LEGAL
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When was your business founded?¿Cuando se fundó su empresa?
*
-
Month
-
Day
Year
Date
Website Address
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Owner Name Nombre del propietario
*
First Name
Last Name
Driver's License State Estado de la licencia de conducir
Expiration Date Fecha de expiración
*
-
Month
-
Day
Year
Date
Date of Birth Fecha de nacimiento
*
-
Month
-
Day
Year
Date
Address & Contact Information Dirección e información de contacto
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number Número de teléfono
*
Format: (000) 000-0000.
Email
*
example@example.com
Ownership %
*
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Processing Information
This section pertains to information about your business’s credit card processing and acceptance.
Bank Account Number
*
Bank Routing Number
*
Does this business currently accept credit cards? ¿Esta organizacion actualmente acepta tarjetas de crédito?
Yes
No
Monthly Volume Volumen mensual
*
Average Transaction Amount Monto promedio de transacción
*
Max Transaction AmountMonto máximo de transacción
*
Describe your product/service. Describe tu producto/servicio.
*
Submit
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