20%

Contact Information

Company Name*

Primary Contact Name*

Primary Contact Phone*

Primary Contact Email*

Is Primary Contact an Owner?*

Yes

What is your percent of ownership?*

100%

Other

What is Your Percentage of Ownership?*

How many owners have 25% or more ownership?*

* Including you, if you selected yourself as an owner.

What is the country of formation?*

USA

Other

What is your other Country of formation?

What is the state of formation?

Are you currently processing credit cards?

Yes

How do you sell products/services? (select all that apply)

Card Not Present (Website, Phone, Contracts)

Card Present (Retail, Events, In-person mobile)

Methods of Sales (Card Not Present)

Website

Phone

Contract / Invoice

Other

What is your website URL?

Describe other method of selling (Card Not Present)

Methods of Sales (Card Present)

Retail

Live Events

Mobile Sales

Other

Describe other method of selling (Card Present)

What is/are your Billing Model? (select all that apply)

One Time Purchase

Recurring/Subscription

Installment

Trial Offer+Subscription

Other

Describe the Other Billing Model

Estimated Monthly Sales Volume

Supporting Documents

Select all support documents available to upload with this application now:

Owner #1

Owner #1 ID Verification

Driver License or Passport

Driver License

Passport

Drivers License - Owner #1*

Passport - Owner #1*

Owner #2

Owner #2 ID Verification

Driver License or Passport

Driver License

Passport

Drivers License - Owner #2*

Passport - Owner #2*

Owner #3

Owner #3 ID Verification

Driver License or Passport

Driver License

Passport

Drivers License - Owner #3*

Passport - Owner #3*

Owner #4

Owner #4 ID Verification

Driver License or Passport

Driver License

Passport

Drivers License - Owner #4*

Passport - Owner #4*

Company Verification - Articles

Articles of Organization/Incorporation.

Certification of Formation

Articles of Organization/Incorporation - Upload*

Company Verification - IRS Documents

Form SS-4 is issued by the IRS when you apply for Tax ID or EIN

Tax ID / Form SS-4

Tax ID / Form SS-4 - Upload*

Banking / Processing Verification

Bank Account Verification

Voided Check or signed Bank Letter

* View a sample signed Bank Letter template here

Voided Check or signed Bank Letter Upload*

Bank Statements

If company is new, provide 3 months personal Bank Statements.

3 months of most recent Bank Statements

1st Month Bank Statement - Upload

2nd Month Bank Statement - Upload

3rd Month Bank Statement - Upload

Processing Statements

3 months of most recent Merchant Processing Statements / Reports

1st Month Processing Statement - Upload

2nd Month Processing Statement - Upload

3rd Month Processing Statement - Upload

Financial Verification
* Choose one of the following to upload

Financial Statement Verification

Year to date and previous years Balance Sheet and Income Statement

Financial Statements

Year to Date Financial Statement - Upload*

Previous Year Financial Statement - Upload*

Tax Returns Financial Documents

If a new company, please provide Personal Tax Returns.

Tax Returns of the last 2 years

1st Year Tax Return - Upload*

2nd Year Tax Return - Upload*

Ownership Details:

Ownership Info # 1

*If you selected yourself as an owner, this is your information.

Owner # 1 Name

First

Last

Owner # 1 Title

Is the address on your Drivers License used for any of the following (mark all that apply)

Current Home

Business Physical location

Business Mailing Address

Owner # 1 Address:

Street

City

State

Zip

Owner # 1 Phone Number

Owner # 1 Email

Owner # 1 Ownership %

Owner # 1 ID State

Owner # 1 ID Number

Owner # 1 Date of Birth

Ownership Info # 2

Owner # 2 Name

First

Last

Owner # 2 Title

Is the address on your Drivers License used for any of the following (mark all that apply)

Current Home

Business Physical location

Business Mailing Address

Owner # 2 Address:

Street

City

State

Zip

Owner # 2 Phone Number

Owner # 2 Email

Owner # 2 Ownership %

Owner # 2 ID State

Owner # 2 ID Number

Owner # 2 Date of Birth

Ownership Info # 3

Owner # 3 Name

First

Last

Owner # 3 Title

Is the address on your Drivers License used for any of the following (mark all that apply)

Current Home

Business Physical location

Business Mailing Address

Owner # 3 Address:

Street

City

State

Zip

Owner # 3 Phone Number

Owner # 3 Email

Owner # 3 Ownership %

Owner # 3 ID State

Owner # 3 ID Number

Owner # 3 Date of Birth

Ownership Info # 4

Owner # 4 Name

First

Last

Owner # 4 Title

Is the address on your Drivers License used for any of the following (mark all that apply)

Current Home

Business Physical location

Business Mailing Address

Owner # 4 Address:

Street

City

State

Zip

Owner # 4 Phone Number

Owner # 4 Email

Owner # 4 Ownership %

Owner # 4 ID State

Owner # 4 ID Number

Owner # 4 Date of Birth

Company Details

Company Formation State

Company Formation Date

Tax ID / EIN

Bank Account Routing Number

Bank Account Number

Business Physical Location Address:

Street

City

State

Zip

Is Company Mailing Address the same as Business Physical Address?

Yes

Business Mailing Address:

Street

City

State

Zip

Products or Services Sold

Customer Service Phone Number

Customer Service Email

Product or Service Sold

Preferred Descriptor

How you would like the customer to see the transaction on their credit card statement

Average Ticket Amount

What is the typical transaction amount?

Maximum Ticket Amount

What is the largest transaction amount you will accept?

How long before your customer has all products / services?

Who performs the product / service fulfillment?

What device will you use to process your transactions?

Describe other method for processing your transactions

Shopping Cart/CRM software

If Using Shopify, Which Plan Applies?

Describe other CRM/Shopping cart used

I have read and agree to the Terms of Service & Privacy Policy

This field should be left blank

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Contact Information

Supporting Documents

Select all support documents available to upload with this application now:

Owner #1

Owner #2

Owner #3

Owner #4

Banking / Processing Verification

Financial Verification * Choose one of the following to upload

Ownership Details:

Ownership Info # 1

Owner # 1 Name

Owner # 1 Address:

Ownership Info # 2

Owner # 2 Name

Owner # 2 Address:

Ownership Info # 3

Owner # 3 Name

Owner # 3 Address:

Ownership Info # 4

Owner # 4 Name

Owner # 4 Address:

Company Details

Business Physical Location Address:

Business Mailing Address:

Products or Services Sold

Financial Verification
* Choose one of the following to upload