Merchant Application
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Banks now requiring minimum of 1 year in business
Legal Entity Name
*
DBA Name
Business Phone Number
*
-
Area Code
Phone Number
Legal Entity Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Incorporation State
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Federal Tax ID
*
Start Date
*
-
Month
-
Day
Year
Owner Information
Full Name
*
First Name
Last Name
Title
*
Email
*
Percentage of Ownership
*
Current Ownership Start Date
*
-
Month
-
Day
Year
Date of Birth
*
-
Month
-
Day
Year
Current Residence Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Owner Mobile Number
*
-
Area Code
Phone Number
Authorized Contact
Full Name
First Name
Last Name
Email
Phone Number
-
Area Code
Phone Number
Required Documents
Copy of Voided Business Check
*
Select Files
The Name Must Match the Business Name
Cancel
of
Driver's License
*
Select Files
Cancel
of
Business Articles of Incorporation
*
Select Files
Cancel
of
New Companies (click to expand)
Two Years Personal Tax Returns
Select Files
Cancel
of
Three Months Personal Bank Statements
Select Files
Cancel
of
Save
Submit
Clear Form
Existing Companies (click to expand)
Three Months Processing Statements
Select Files
Cancel
of
Three Months Business Bank Statements
Select Files
Cancel
of
Save
Submit
Clear Form
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