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Pre-Application Form
Legal Business Name
*
Type of Ownership
Sole Proprietor
Partnership
Corporation
LLC/LLP
Non-Profit
Tax ID Number
*
Date Business Started
*
DBA Organization Name
*
DBA Organization Address
*
DBA City
*
DBA State
*
DBA ZIP Code
*
DBA Phone Number
Is this a seasonal business?
*
Choose one
Yes
No
What is your return, cancellation, or refund policy?
Owner's Full Name
*
Owner's Date of Birth
*
Owner's Social Security #
*
Owner's Home Address
*
City
*
State
*
ZIP Code
*
Phone Number
*
Owner's Email Address
*
Bank Name
*
Bank Routing Number
*
Bank Account Number
*
Product/Service Sold
*
How are products sold?
*
In Store
Online
Phone
Website Address
Do you currently accept credit cards?
*
Choose one
No
Yes
If yes, what processor are you with?
Current or estimated monthly volume? (All Outlets)
*
Average transaction amount?
*
What would be a high transaction amount?
*
Reason for high transaction amount?
*
How did you hear about us?
Best time to reach you to review your application?
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