Merchant Processing Application Business Legal Name*(Required) DBA*(Required) Business Type (Legal Entity i.e.: Corporation, LLC, etc.) Federal Tax ID (EIN) State Registered MM slash DD slash YYYY Date Registered DD dash MM dash YYYY Banking InformationBank Name Bank Account Name Bank Routing Number Bank Account Number Contact InformationContact Mailing Address*(Required) Statement Mailing Address Ship To Address(Required)Business Email*(Required) Business Website* Primary Contact Name*(Required) Primary Contact Mobile Phone*(Required)Ownership InformationOwner Name Owner Email Percent of Business Owned DOB MM slash DD slash YYYY SS# DL# Issuing State Home Address*(Required) Additional Owner Information, if ApplicableAdditional Owner Information, if Applicable Yes No Additional Owner InformationOwner Name Owner Email Percent of Business Owned DOB MM slash DD slash YYYY SS# DL# Issuing State Home Address*(Required) Financial InformationGross Annual Sales Average Annual Credit Card Volume: Highest Ticket AmountAverage Ticket AmountProperty InformationOwn or Rent Location Landlord Name Landlord PhoneLease Term Lease Start Date MM slash DD slash YYYY Δ
