MERCHANT APPLICATION

Legal Business Name *

Website

Business Address *

Home Mailing Address *

Business Phone *

Best Contact Email *

Entity Type *

If other type in next section

Sole Proprietorship
Partnership
Corporation
LLC
Non-Profit Government/Municipality
Other
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If other, type here

EIN/ ITIN/ SIN

What is website hosted on

1ST OWNER/OFFICER

Full Name *

Date of birth *

1st Owners Title *

Percent of Ownership *

Home Address *

1st Owner Email *

1st Owner Phone *

1st Owners Social Security Number or Equivalent *

2ND OWNER/OFFICER

(If owns more than 25%) Fill out ALL FIELDS

2nd Owners Name

2nd Owners Birth Date

2nd Owners Title

2nd Owners Percentage of Ownership

2nd Owners Home Address

2nd Owners Email

2nd Owners Phone Number

2nd Owners Social Security Number(or equivalent)

3RD OWNER/OFFICER

(If owns more than 25%) Fill out ALL FIELDS

3rd Owners Name

3rd Owners Birth Date

3rd Owners Title

3rd Owners % of Ownership

3rd Owners Address

3rd Owners Email

3rd Owners Phone Number

3rd Owners Social Security Number(or equivalent)

BUSINESS INFORMATION

Date Business Started *

Link or how to find return policy *

% of Sales Returned *

% of Sales that Chargeback *

When are Cards Charged *

Immediately
Same Day
Upon Delivery/ Completion of Service
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Signatures required for purchase *

Yes
No
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Estimated Monthly Revenue *

Product or service offered *

Estimated Average Sale *

Estimated Max Sale Size *

Card Sale Method *

Swiped in person
Online cart checkout
Virtual invoice/ pay link
Over Phone/ manual entry
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Estimated % of AMEX sales *

Link ANY Relevant Social Media Accounts

REQUIRED DOCUMENTS

Each Owners Drivers License *

Or passports

Voided Business Check or Bank Verification Letter

If you dont have access to either, please contact your bank requesting either

EIN Letter (or equivalent)

Previous 3 Months of Business Bank Statement *

Instructions to find processing statements:

HERE

Previous 3 Months Processing Statements *

If this is a new business or doesnt have processing history, submit last 3 months personal bank statements of 1st owner

Fulfillment Agreements

ex: service agreement, 3PL agreement, shipping agreement, SAAS deliverables, agency deliverables etc.

Chargeback protection agreement and 3 months reports

If using chargeback protection, attach agreement with company and last 3 months of reports

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