| Email Address* |
|
| Legal Business Name* |
|
| DBA Name |
|
| Business Location |
|
| City
|
State
Zip
|
| Country |
|
| Business Form |
|
| Business EIN # |
|
| Confirm EIN# |
EIN is 100% Correct
Dont Have One |
| Business Phone |
|
| Business Fax |
|
| Website Address |
|
| Describe Products |
|
| Average Sale Price |
|
| Monthly Card Volume |
|
| Transaction Type |
Face-To-Face SWIPED
Phone Orders KEYED
eCommerce Sales
|
| Accept Cards Now |
Yes Currently Processing
Processing Closed
Never Processed
|
| Current Statements |
|
| Business Start Date |
|
|
| STEP TWO |
Owner Information |
| Owners Name* |
|
| Home Address |
|
| City
|
State
Zip
|
| Country |
|
| Principal's Title |
|
| Ownership % |
|
| Drivers License# |
|
| Credit Score |
|
| Social Security# |
|
| Date Of Birth |
|
| Cell Phone* |
|
| Best Time To Call |
Morning
Afternoon
Evening
|
