SoftLedger Pay Intake Form
Company Information
Please provide the details for the legal entity applying for a SoftLedger Pay merchant account below. If multiple entities will receive payments, please complete a separate form for each legal entity.
Legal Name of Business
DBA (if different)
Address
Main support email
example@example.com
Main support phone number
Format: (000) 000-0000.
Federal Tax ID (e.g. EIN)
Business start date
-
Month
-
Day
Year
Date
Type of corporation (check one)
Sole Proprietorship
LLC/LLP
C Corp
S Corp
Government
501C
Give us a short description of your business
Has your business ever declared bankruptcy? (check one)
Yes
No
What types of payments do you plan to accept through SoftLedger Pay?
Credit Card
ACH
Do you intend to pass credit card and/or ACH fees through to your customers?
Yes
No
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Ownership information: Required for all owners of 25% or more
If there are no owners greater than 25%, please include a major shareholder or key employee.
Owner #1
Name
Title
Date of birth
-
Month
-
Day
Year
Date
SSN
% Ownership
Address
Phone
Format: (000) 000-0000.
Email
example@example.com
Personal Guarantor (check one)
Yes
No
Personal Bankruptcy (check one)
Yes
No
Driver's License Front
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Driver's License Back
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Owner #2
(if applicable)
Name
Title
Date of birth
-
Month
-
Day
Year
Date
SSN
% Ownership
Address
Phone
Format: (000) 000-0000.
Email
example@example.com
Personal Guarantor (check one)
Yes
No
Personal Bankruptcy (check one)
Yes
No
Driver's License Front
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Driver's License Back
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Owner #3
(if applicable)
Name
Title
Date of birth
-
Month
-
Day
Year
Date
SSN
% Ownership
Address
Phone
Format: (000) 000-0000.
Email
example@example.com
Personal Guarantor (check one)
Yes
No
Personal Bankruptcy (check one)
Yes
No
Driver's License Front
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Driver's License Back
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Bank Information
Each SoftLedger Pay merchant account can only be linked to one bank account. If multiple bank accounts are required, please complete a separate intake form for each bank account.
Account Holder Name
Bank Name
Routing Number
Account Number
Voided Check or Bank Letter
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Average Credit Card Transaction
High Credit Card Transaction
Average Monthly Volume of Credit Card Transactions
Average ACH Transaction
High ACH Transaction
Average Monthly Volume of ACH Transactions
Past 3 Months of Payment Processing Statements (if applicable)
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Additional Documents (if applicable)
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