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)Mobile(Required)Email(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)Average 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
