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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) CountryUSState*(Required) City*(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 PostReferralExisting ClientOtherOther How Soon Do You Need Merchant Account*(Required)How Soon Do You Need Merchant AccountWithin 7 DaysWithin 15 DaysWithin 30 DaysPrevious/Current Merchant Account Provider*(Required) Average Ticket Size*(Required) Maximum Ticket Size*(Required) Business DescriptionOwner information Name*(Required) Owner First Name Owner Last Name Title*(Required) Ownership %*(Required) DOB*(Required) MM slash DD slash YYYY SSN*(Required) Home Address Line 1*(Required) Home Address Line 2*(Required) CountryUSState*(Required) City*(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. Void Check*(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 (Last 3 month) 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. Merchant's Statements (Last 3 month) 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. Add Multiple Owner Add Second Owner Second Owner Information Name*(Required) Owner First Name Owner Last Name Title*(Required) Ownership %*(Required) DOB*(Required) MM slash DD slash YYYY SSN*(Required) Home Address Line 1*(Required) Home Address Line 2*(Required) CountryUSState*(Required) City*(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. Third owner details Add Third Owner Third Owner Information Name*(Required) Owner First Name Owner Last Name Title*(Required) Ownership %*(Required) DOB*(Required) MM slash DD slash YYYY SSN*(Required) Home Address Line 1*(Required) Home Address Line 2*(Required) CountryUSState*(Required) City*(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. Fourth owner details Add Fourth Owner Fourth Owner Information Name*(Required) Owner First Name Owner Last Name Title*(Required) Ownership %*(Required) DOB*(Required) MM slash DD slash YYYY SSN*(Required) Home Address Line 1*(Required) Home Address Line 2*(Required) CountryUSState*(Required) City*(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. Fifth Owner Details Add Fifth Owner Fourth Owner Information Name*(Required) Owner First Name Owner Last Name Title*(Required) Ownership %*(Required) DOB*(Required) MM slash DD slash YYYY SSN*(Required) Home Address Line 1*(Required) Home Address Line 2*(Required) CountryUSState*(Required) City*(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. CAPTCHA Δ
