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Merchant Account Processing Application
Step
1
of
3
- Personal
0%
Principal / Business Owner
*
First
Last
Title
*
Please Select
Owner
President
CEO
Vice President
Partner
Manager
Business Ownership %
*
Personal Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Year Moved In
*
Cell Phone Number
*
Social Security Number
*
Driver's License Number
*
Driver's License State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Date of Birth
*
Month
Day
Year
Email
*
Estimated FICO Score
*
Business / DBA Name
*
Business Legal Name
*
Business Type
*
Please Select
LLC
Corporation
Sole Proprietorship
Partnership
Medical / Legal Corporation
Government
Association / Estate / Trust
Non-Profit
Tax Exempt Organization
International Organization
Date Business Established
*
Month
Day
Year
Federal EIN
*
Business Phone #
*
Business Website
Is the Business Address the same as the Principal/Business Owners Address?
*
Please Select
Yes
No
Business Address *
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
The mailing address for the company is:
*
Please Select
The same as the business owner address
The same as the business address
I have a separate mailing address
Mailing Address *
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is the Primary Business Contact the same as the Principal / Business Owner?
*
Please Select
Yes
No
Hidden
Primary Business Contact *
First
Last
Title *
Phone # *
Email *
Briefly Describe Merchandise/Services Sold
*
Average Ticket Amount
*
Anticipated Average Credit/Debit Card Sale Transaction Size
Average Monthly Volume
*
Average Total Monthly Credit/Debit Card Sales Expected
Highest Ticket Amount
*
Largest Aniticipated Credit/Debit Sale Transaction Size
Percent of "Card Present" Transactions
*
Percent of Transactions Completed Face-to-Face With Customers
Percent of "Card Not Present" Transactions
*
Percent of On-line or Phone Transactions
Accepted Electronic Payment Methods (Check All That Apply)
*
I have a Merchant Account to take Credit/Debit Cards
I use Paypal, Stripe or Square to take Credit/Debit Cards
ACH / Electronic Bank Transfers
Mobile Payments
EBT
Current Merchant Account Processor *
Current Merchant ID Number *
Have any of the owners of the business ever had a bankcard relationship terminated? *
Please Select
Yes
No
Business Bank Name:
*
Bank Routing Number
*
Business Checking Acct. #
*
Documents Required For Prequalification
A copy of your Driver's License
*
Max. file size: 10 MB.
A copy of a voided check from your business account, or you may upload a letter from your bank with your business bank account number and the bank routing number.
*
Max. file size: 10 MB.
A copy of your business Articles of Organization or Articles of Incorporation
*
Max. file size: 10 MB.
A copy of your business EIN letter with your Employer Identification Number. This is the SS-4 document your received from the IRS.
*
Max. file size: 10 MB.
A copy of your latest monthly processing statement from your merchant processor. Must show all transactions and fees paid (not just a Summary Report). *
Max. file size: 10 MB.
A copy of a report containing the transactions from last full month of your Paypal, Stripe or Square account. Must show all transactions and fees paid (not just a Summary Report). This can typically can exported from within the app to a CSV file and you can just attach that file. *
Max. file size: 10 MB.
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