Merchant Services Application

Business Information

Business Legal Name: *

DBA Name: *

Federal Tax ID # *

Enter Numbers Only

Industry type *

Type of entity *

Monthly Credit Card Volume *

Average Credit Card Transaction *

Highest Credit Card Transaction *

Business Start Date *

Business Phone # *

Business Address *

City *

State Corporation *

Country *

Country

Postal Code *

Home Based Business *

YES

NO

How Many Owners? *

1

2

Owner Information

First Name *

Last Name *

Phone Number *

OWNERSHIP PERCENTAGE *

SSN: *

Date of birth *

HOME ADDRESS *

Email *

Driver's LICENSE

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

vOIDED CHECK

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

BANK STATEMENT 1

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

BANK STATEMENT 2

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

BANK STATEMENT 3

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

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