Which Processing Program are you going with?
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Were You Working With A Specific Agent/ISO?
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If Other, Which ISO/Agent were you working with?
Tax Rate(s)
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Would you like to be able to manually enter card info? We can program it on either the customer facing payment terminal or the merchant/employee screen
Would you like to offer tipping on card transactions?
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There will be a No Tip option and a Custom Tip option in addition to 3 dedicated percentage amounts: 20%, 30%, 40%. If you would like 3 different percentage options list them below
Business Name (Doing Business As)
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DBA Street Address
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DBA City, State, & Zip Code
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Location Phone #
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Legal/Corporate Name
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Corporate Street Address
Corporate City, State, & Zip Code
Where do you want hardware shipped? (DBA address, Corporate/Legal address, or enter another address)
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Fed Tax ID/EIN
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Bank Account #
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Bank Routing #
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Voided Check or Bank Letter (Bank Letter must be a pdf from your banker showing the bank's letterhead, your name, business name, and account/routing numbers to verify banking info)
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PDF, PNG, JPEG or JPG
Previous Month's Card Processing Statement (required for merchants processing more than $75,000 in monthly card volume)
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Estimated Average Ticket Amount
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Estimated High-End Ticket Amount
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Estimated Monthly Card Volume
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Estimated Monthly Amex Volume
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Date Business Started
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Who is your shop's Internet Service Provider?
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Type of Ownership
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Product / Service Sold
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What is your return, cancellation, or refund policy?
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Owner #1 Full Name
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Equity Ownership %
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Are there any additional owners? We need a minimum of 50% ownership represented.
Social Security #
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Business Email
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Phone #
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Date of birth
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Residence Street Address
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Residence City, State, & Zip Code
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Driver's License
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PNG, PDF, JPEG or JPG
Owner #2 Full Name
Owner #2 Equity Ownership %
Owner #2 Social Security #
Owner #2 Email
Owner #2 Phone #
Owner #2 Date of Birth
Owner #2 Residence Street Address
Owner #2 Residence City, State, & Zip Code
Owner #2 Driver's License
PDF, PNG, JPEG or JPG
Owner #3 Full Name
Owner #3 Equity Ownership %
Owner #3 Social Security #
Owner #3 Email
Owner #3 Phone #
Owner #3 Date of Birth
Owner #3 Residence Street Address
Owner #3 Residence City, State, & Zip Code
Owner #3 Driver's License
PDF, PNG, JPEG or JPG
Owner #4 Full Name
Owner #4 Equity Ownership %
Owner #4 Social Security #
Owner #4 Email
Owner #4 Phone #
Owner #4 Date of Birth
Owner #4 Residence Street Address
Owner #4 Residence City, State, & Zip Code
Owner #4 Driver's License
PDF, PNG, JPEG or JPG
Preferred T Shirt Size
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