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Corporate Legal Info

Company Name

Mailing Address

Physical Location Address

Primary Contact Name

Primary Contact Email

Primary Contact Phone

EIN Tax ID#

Date Business Started

State of Organization

# Owners having 25% or more ownership*

Product / Service Info

Product / Services Sold

Website/URL

Descriptor (21 digits)

Customer Service Phone Number

Customer Service Email

Average Transaction Amount $

Max Transaction Amount $

Offer (Trial / Straight Sale / Subscription/ Retail)

Ownership Info #1

Name

Home Address

How long at current residence

Own or Rent/Lease

Home Phone (MUST not be a virtual #)

Owner Email

Social Security#

% Ownership

Owner’s Title

Driver’s License# & State

Date of Birth

Ownership Info #2

Name

Home Address

How long at current residence

Own or Rent/Lease

Home Phone (MUST not be a virtual #)

Owner Email

Social Security#

% Ownership

Owner’s Title

Driver’s License# & State

Date of Birth

Ownership Info #3

Name

Home Address

How long at current residence

Own or Rent/Lease

Home Phone (MUST not be a virtual #)

Owner Email

Social Security#

% Ownership

Owner’s Title

Driver’s License# & State

Date of Birth

Ownership Info #4

Name

Home Address

How long at current residence

Own or Rent/Lease

Home Phone (MUST not be a virtual #)

Owner Email

Social Security#

% Ownership

Owner’s Title

Driver’s License# & State

Date of Birth

Standard Items Needed

Color copy of Driver’s License of Signing Officer(s)

Articles of Incorporation / Organization

SS-4 Form (letter from IRS verifying the Tax ID #)

Voided Business Check (no temporary checks, must be pre-printed check in the legal company name) OR Signed Bank Account Verification Letter (on bank letterhead & must confirm Company Name, bank acct #, routing # and be signed by Bank Representative)

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