Business Information

Legal Business Name *

Doing Business As (DBA)

Business Structure *

Industry *

Products or Services Offered

Employer Identification Number (EIN)

Business SSN

Business Email

Business Phone

Website

Business Address

City

State

Postal Code

Owner Information

Owner First Name

Owner Last Name

Owner Title or Role

Owner Date of Birth

Owner Phone

Owner Email

Owner SSN

Ownership Percentage

Owner Home Address

Liaison Information

Liaison Name

Liaison Email

Liaison Phone *

Special Instructions

Financing and Business Profile

Estimated Annual Financing Volume *

Average Order Value *

Years in Business *

Does the business accept refunds?

Yes

Refund Window in Days

Banking Information

Bank Account Number

Bank Routing Number

Agreements

I acknowledge that I am an eligible merchant and am authorized to enter this agreement.

I accept the Tua Financial General Terms.

I accept the Tua Financial Privacy Policy. *

I agree

I have read the Eligible Merchant Agreement and have the authority to bind and execute this agreement on behalf of the Merchant company. *

I agree