Please fill the form out below. We will be sending you your application within the next 24 hours for esignature.

All documents must be in pdf format. If you do not have a scanner, we suggest you go to your phone's app store and download Adobe Scan (it's free). You can use it to scan single and multi page documents. Please label the documents with "YOUR COMPANY NAME" followed by the title of document (i.e. XYZ Company EIN Letter or XYZ Company Jane Doe Drivers License).

Main Contact is:

First Name *

Last Name *

Phone *

Email *

Corporate/Legal Name *

Corporate Street Address *

Corporate City *

Corporate Zip *

Merchant Name/DBA *

Corporate State *

DBA/Location Address *

DBA/Location State *

DBA/Location City *

DBA/Location Zip *

Business Phone

Business Email

Federal Tax ID# *

Years in Business *

Choose Mailing Address *

# of Locations *

Has merchant or owners/principal ever been terminated from accepting bankcards for this business or any other business?

Yes

Information for all owners is needed for anyone

with a 25% stake or higher.

Owner #1 Name *

Owner #1 Title *

Owner #1 % of Ownership *

Owner #1 Home Street Address *

Owner #1 Home City *

Owner #1 Home State *

Owner #1 Home Zip *

Owner #1 MOBILE Phone *

Owner #1 Social Security # *

Owner #1 DOB *

Owner #1 Email Address *

Owner #1 Driver's License # *

Owner #1 Driver's License State *

Owner #2 Name

Owner #2 Title

Owner #2 % of Ownership

Owner #2 Home Street Address

Owner #2 Home City

Owner #2 Home State

Owner #2 Home Zip

Owner #2 MOBILE Phone

Owner #2 Social Security

Owner #2 DOB

Owner #2 Email Address

Owner #2 Driver's License State

Owner #2 Driver's License #

Owner #3 Name

Owner #3 Title

Owner #3 % of Ownership

Owner #3 Home Street Address

Owner #3 Home City

Owner #3 Home State

Owner #3 Home Zip

Owner #3 MOBILE Phone

Owner #3 Social Security

Owner #3 DOB

Owner #3 Email Address

Owner #3 Driver's License #

Owner #3 Driver's License State

Owner #4 Name

Owner #4 Title

Owner #4 % of Ownership

Owner #4 Home Street Address

Owner #4 Home City

Owner #4 Home State

Owner #4 Home Zip

Owner #4 MOBILE Phone

Owner #4 Social Security

Owner #4 DOB

Owner #4 Email Address

Owner #4 Driver's License #

Owner #4 Driver's License State

Average Ticket? *

Maximum Ticket *

Ownership Type *

Bank Name *

Full Bank Address: *

Bank Routing # *

Bank Routing # (Confirm) *

Bank Account # *

Bank Account # (confirm) *

Describe refund policy: *

Merchant: *

Landlord's Name & Full Address *

How will this product be advertised or promoted? *

List the name(s) and address(es) of the vendor(s) from which supplies are purchased: *

Please list equipment and/or software to process cards (POS, terminal, Gateway, etc)

Who performs product/service fulfillment? If different from vendor, please provide Vendor Name, address, and phone in full: *

SALES METHOD

(Must Equal 100%)

In Person / Mail/Phone / Ecommerce

In Person

Mail/Phone

Ecommerce

Please include website access details for any gated product pages or member restricted area/store fronts. These will need to remain active the entire time you are processing with the provider.

Username 1

Password 1

Username 2

Password 2

Do you offer recurring and time-extended services (Subscriptions, memberships, recurring plans, etc). If Yes, please describe and include duration.

What % of their sales is B2B?

What % of their sales is to Consumers?

What % of their sales is: to Government?

What % of their business will be international sales?

All documents must be in pdf format. Thank you!

Owner #1 Colored Copy of the Driver's License *

Owner #1 Selfie Holding Colored Copy of the Driver's License Up Close *

Owner #2 Colored Copy of the Driver's License

Owner #2 Selfie Holding Colored Copy of the Driver's License Up Close

Owner #3 Colored Copy of the Driver's License

Owner #3 Selfie Holding Colored Copy of the Driver's License Up Close

Owner #4 Colored Copy of the Driver's License

Owner #4 Selfie Holding Colored Copy of the Driver's License Up Close

3 Months Full Business Bank Statements

3 Months Full Payment Processing Statements

Voided Business Check *

State Business Registration Paperwork

EIN Letter *

Operating Agreement/Partnership Papers (if Applicable)

If using 3rd party fulfillment house, copy of the agreement

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