Sign Up testting form Business InformationCompany Name(Required) Legal Name(Required) Name(Required) Contact First Name Contact Last Name Business Address Line 1(Required) Business Address Line 2(Required) City(Required) State(Required) Zip(Required) Business Phone(Required)✓ Valid number ✕ Invalid numberMobile(Required)✓ Valid number ✕ Invalid numberEmail(Required) Website(Required) Entity Type(Required) Business Start Date(Required) MM slash DD slash YYYY State of Formation(Required) Account Type(Required)Account TypeRetailE-CommerceRestaurant & BarBusiness to BusinessService ProfessionalsAutomotiveFitness/HealthNonprofitHigh RiskHospitalityVeterinaryGroceryLiquor/ConvenienceFederal Tax ID(Required) Business Address(Required) City(Required) State(Required) Zip(Required) Corporate Phone(Required)✓ Valid number ✕ Invalid numberAverage Monthly Sales(Required)Average Monthly Sales$0 to $10k$10k to $50k$50k to $100k$100k to $500k$500k to $1M$1M+How Did You Hear About us?(Required)How Did You Hear About us?Social Media (Facebook, Instagram, Twitter)Google/Search EngineGoogle AdsYouTube AdsYelp SearchEmail NewsletterBlog PostHow Soon Do You Need Merchant Account(Required)How Soon Do You Need Merchant AccountWithin 7 DaysWithin 15 DaysWithin 30 DaysPrevious/Current MerchantAccount Provider(Required) Average Ticket Size/Maximum Ticket Size(Required) Business DescriptionOwners information Name(Required) Owner First Name Owner Last Name Title(Required) Ownership %(Required) DOB(Required) MM slash DD slash YYYY SSN(Required) Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Address(Required) City(Required) State(Required) Zip(Required) Business License/EIN Confirmation/Article of Incorporation/File Receipt(Required) Drop files here or Select files Accepted file types: jpg, png, svg, gif, csv, pdf, doc, zip, webp, doc, docx, jpeg, Max. file size: 1 GB, Max. files: 5. Driver License/State ID/Federal ID(Required) Drop files here or Select files Accepted file types: jpg, png, svg, gif, csv, pdf, doc, zip, webp, doc, docx, jpeg, Max. file size: 1 GB, Max. files: 5. Bank Statements(Required) Drop files here or Select files Accepted file types: jpg, png, svg, gif, csv, pdf, doc, zip, webp, doc, docx, jpeg, Max. file size: 1 GB, Max. files: 5. CAPTCHA Δ
