Application

This is the application for credit card processing. Questions like average ticket, maximum ticket size and monthly volume, give your best estimate. (There is no wrong answer.)

Contact Name: *

Contact Email: *

Contact Phone Number: *

Business Name: *

Business Mailing Address: *

Business DBA if Different:

Business Physical Address: *

Taxpayer ID Number (9) Digits: *

Business Phone No: *

Business Fax No (optional):

Ownership/Guarantor Information List all owning 25% or more of business equity. Use Message box to list additional.

Name (1): *

Ownership Percentage *

Mobile Number: *

Social Security Number:

Home Address: *

Date of Birth: *

City/State/Zip: *

Name (2):

Ownership Percentage:

Phone No:

Social Security Number:

Home Address:

Date of Birth:

City/State/Zip

Type of Ownership: *

Type of Business: *

Bank Routing Number: *

Bank Name: *

Type of Goods and Services Sold: *

Bank Account Number: *

Bank Phone Number: *

Mail Order and Telephone Order – Provide Website:

Average Ticket: *

% Swiped

How long have you been in business?

Maximum Ticket: *

% Keyed in

Average Monthly Volume: *

Message

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Ownership/Guarantor Information List all owning 25% or more of business equity. Use Message box to list additional.

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