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LOCATION INFORMATION
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Step
1
of 4
Legal Name:
*
Legal Address:
*
Layout
Legal City
*
Legal State
*
Legal Zip
*
Entity Type: (Select LLC for all Partnerships)
*
LLC
Corporation
Sole Proprietor
Layout
Federal Tax ID
*
Entity Start Date:
*
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Business (DBA) Name
*
Business Address
*
Layout
Business City
*
Business State
*
ZIP code
*
Contact Name:
*
Location Phone:
*
Business Email:
*
Layout
Customer Service Phone:
Fax Number
Website:
Business Information
Products / Services Sold:
*
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Next
Layout
Owner First Name:
*
Owner Last Name:
*
Layout
Title:
*
Ownership %
*
Home Address:
*
Layout
City:
*
State:
*
Zip Code:
*
Home Phone:
*
Cell Phone Number
*
Social Security #:
*
Date of Birth
*
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YYYY
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Layout
Driver License #
DL State:
Driver's License: (To expedite the processing of your application please attach a picture of your driver's license.)
Click or drag a file to this area to upload.
Email
*
Previous
Next
Sales Profile
What percentage of your sales are business to business (B2B) and what percentage of your sales are business to consumers (B2C)
B2B%
B2C %
Layout
Processing Volume
Requested Monthly Volume
*
Layout
Avg Transaction Size
*
Max Transaction Size
*
Settlement Bank Info
Layout
Bank Name:
*
Account Number:
*
Layout
Routing Number:
*
Type
*
Saving
Checking
Voided Check: (Please include a picture of a voided check with your business name and address printed by your bank. Your funds will be deposited to this account.)
Click or drag a file to this area to upload.
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