NEXT STEPS

Legal Business Name *

Legal Business Address *

Business Phone

(###)

###

####

DBA Name *

DBA Address

If different from legal

Mail statements to: *

Type of Ownership *

Federal Tax ID *

Business Website

http://

Are you currently processing credit card payments? If so, what equipment/software are you using?

What is your average monthly credit card volume? *

What is the highest transaction you expect to run? *

Please provide the following information for each individual who owns 25% or more of the equity interest of your business.

Principal 1 *

Please provide the following information for each individual who owns 25% or more of the equity interest of your business.

Principal 1

First Name

Last Name

Principal 1 will be the signer of the application. We will send a link for digital signature to the email address below.

Home Address *

SSN *

DOB *

DOB

YYYY

Percent of Ownership *

Principal 2

First Name

Last Name

Home Address

SSN

DOB

YYYY

Percent of Ownership

Principal 3

First Name

Last Name

Home Address

SSN

DOB

YYYY

Percent of Ownership