Business Information
DBA Name
*
Legal Business Name
*
Business Phone
*
Federal Tax ID
*
How many POS stations?
*
Type of Ownership
*
DBA Address
City
State
Country
Country
Postal Code
Is the DBA address the same as the Legal Address?
*
Yes, the same
No, legal address is different
Legal Address
Street Address (Legal)
*
City (Legal)
*
State (Legal)
*
Zip Code (Legal)
*
Owner Information
Owner First Name
*
Owner Last Name
*
Owner Street Address
*
Owner City
*
Owner State
*
Owner Zip
*
Job Title
*
Owner Phone
*
Owner Email
*
Owner DOB
*
Owner SSN
*
ID Type
*
ID Number
*
Issuing State
*
ID Expiration Date
*
Owner Ownership %
*
Are there any other owners that own 25% or more of the company?
*
Owner 2 Information
Owner 2 First Name
*
Owner 2 Last Name
*
Owner 2 Street Address
*
Owner 2 City
*
Owner 2 State
*
Owner 2 Zip
*
Owner 2 SSN
*
Owner 2 DOB
*
Owner 2 ID Number
*
Owner 2 ID Type
*
Owner 2 ID Expiration
*
Owner 2 Ownership %
*
Banking Details
Name on Bank Account
*
Bank Routing (ABA)
*
Bank Account # (DDA)
*
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