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Integrations
Industries
Service Based Business
Restaurants
Stores
E-Commerce
Automotive
Cannabis
High Risk Business
Other Industries
About
FAQ’s
Contact
Blog
English
Español
Get Started
New merchant. PreApplication
Get Started
Please enable JavaScript in your browser to complete this form.
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Legal Business Name:
*
DBA Name:
*
Legal Address:
*
City, State and ZIP
*
DBA Address:
*
City, State and ZIP
*
Business Phone #:
*
Customer Service Phone #:
*
Fax Number:
*
Contact Email:
*
Sale Method:
*
Store Front
MOTO
E-Commerce
Federal Tax ID(EIN):
*
Website URL:
*
Locations:
*
Average Ticket:
*
Monthly Volume:
*
Contact Name:
*
Products/Services being sold:
*
% Keyed
*
% Swiped:
*
Equipment/Software Used:
*
Type of Business:
*
Business Start Date:
*
Name on Bank Account:
*
Bank Name:
*
Bank Phone #:
*
Routing/Transit #:
*
Account #:
*
First Name
*
Last Name:
*
Middle Initial:
*
Home Address:
*
City, State and ZIP
*
Home Phone #:
*
Principal Email:
*
DOB:
*
Social Security #:
*
Drivers License or Passport #:
*
Ownership %:
*
Controling Individual:
*
Yes
No
Is this Principal a US Citizen:
*
Yes
No
Country of Origin:
*
Submit
