Which Processing Program are you going with? *

Were You Working With A Specific Agent/ISO? *

If Other, Which ISO/Agent were you working with? *

Tax Rate(s) *

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? *

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) *

DBA Street Address *

DBA City, State, & Zip Code *

Location Phone # *

Legal/Corporate Name *

Corporate Street Address

Corporate City, State, & Zip Code

Where do you want hardware shipped? (DBA address, Corporate/Legal address, or enter another address) *

Fed Tax ID/EIN *

Bank Account # *

Bank Routing # *

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) *

Previous Month's Card Processing Statement (required for merchants processing more than $75,000 in monthly card volume)

Estimated Average Ticket Amount *

Estimated High-End Ticket Amount *

Estimated Monthly Card Volume *

Estimated Monthly Amex Volume *

Date Business Started *

Type of Ownership *

Product / Service Sold *

What is your return, cancellation, or refund policy? *

Owner #1 Full Name *

Equity Ownership % *

Are there any additional owners? We need a minimum of 50% ownership represented.

Social Security # *

Business Email *

Phone # *

Date of birth *

Residence Street Address *

Residence City, State, & Zip Code *

Driver's License *

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

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

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

Preferred T Shirt Size *

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