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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
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# Owners having 25% or more ownership
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2
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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)
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Ownership Info #1
Name
Home Address
How long at current residence
Own or Rent/Lease
Please select
Own
Rent/Lease
Home Phone (MUST not be a virtual #)
Owner Email
Social Security#
% Ownership
Owner’s Title
Driver’s License# & State
Date of Birth
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Ownership Info #2
Name
Home Address
How long at current residence
Own or Rent/Lease
Please select
Own
Rent/Lease
Home Phone (MUST not be a virtual #)
Owner Email
Social Security#
% Ownership
Owner’s Title
Driver’s License# & State
Date of Birth
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Ownership Info #3
Name
Home Address
How long at current residence
Own or Rent/Lease
Please select
Own
Rent/Lease
Home Phone (MUST not be a virtual #)
Owner Email
Social Security#
% Ownership
Owner’s Title
Driver’s License# & State
Date of Birth
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Ownership Info #4
Name
Home Address
How long at current residence
Own or Rent/Lease
Please select
Own
Rent/Lease
Home Phone (MUST not be a virtual #)
Owner Email
Social Security#
% Ownership
Owner’s Title
Driver’s License# & State
Date of Birth
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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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