Merchant Application Information

Please tell us about your business and see how much you could save with us.

Business Corporate / Legal Name

Business DBA Name

Business TAX ID / SSN

EBT

Business Address

City

State

Zip Code

Location Phone #

Location Fax #

Contact Name

Date Business Stared (MM/DD/YYYY)

Business Email

Business Type Options

Sole Proprietor Partnership Corporation LLC

Detailed Explanation of Type of Merchandise, Products or Services Sold:

Name: (First, MI, Last)

% Ownership

Title

SSN

D.O.B (MM/DD/YYYY)

Email Address

Owner Mobile Number #

Home Address (NO P.O. BOX)

City

State

Zip Code

Monthly Card Sales

High Ticket

Average Ticket

Monthly Amex Sales

Monthly Total Sales (Cash Included)

Valid copy of drivers license, valid business license copy bank letter or voided check, 3 months of processing statements

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