MERCHANT INFORMATION SHEET

Merchant Pre App Info Sheet
DBA Name
Legal Name
Bar ID (only if using Shop Rate Remover POS)
Business Phone Number
Please enter a valid phone number.
Business Email Address
example@example.com
Business Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Federal Tax Filing Name
About your business

Sole PropS CorpC CorpLLCNon Profit 501c3Partnership
Tax ID #
State Incorporated
Date business began

MonthDayYear
Date
SALES INFORMATION
Product or Service Sold
Avg Monthly Total Credit Card Sales
Average Ticket Purchase
Highest Expected Ticket
OWNER'S INFORMATION (use another page if second owner to be on app) Must have 51% or more ownership
Full Name
Title
Ownership %
Owner cell phone
Please enter a valid phone number.
Owner email if different from business email
Home Address (if not a home based business)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security No.
Date of Birth

MonthDayYear
Date
Driver license number
Prior Bankruptcies?

NoYes
If yes, when discharged? Date
Bank Name
Account Number
Routing Number
Please attach a voided check or signed bank letter if its a starter check or email Nicoledevery02@gmail.com. For questions or sample bank letter, please call or text Nicole at 626-688-3452

Cancelof
Should be Empty:

Merchant Pre App Info Sheet