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Pre-Application Form

Legal Business Name *

Type of Ownership

Sole Proprietor PartnershipCorporationLLC/LLPNon-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 oneYesNo

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 OnlinePhone

Website Address

Do you currently accept credit cards? * Choose oneNoYes

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?

Special Instructions

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This is for form submission only. No user input is required.This is for an anti-spam checkbox only. No user input is required.