Pre-Application

The purpose of this form is to collect basic business and ownership information from you so we can prepare and send off a Merchant Processing Agreement for signature. This site is 128-bit SSL secured.

Please have the following information handy as you complete this form:

Business Tax ID
Bank Account Info
Owner ID info

Step 1 of 3

Business Name*
Business Legal Name*
Entity Type*
State of Incorporation*
State
Phone*
Email*
Enter Email Confirm Email
Business Address*
Street Address Address Line 2 City State ZIP Code
Is the business address the same as the mailing address?*
- Yes
- No (add mailing address)
Address
Street Address Address Line 2 City State ZIP Code
Tax Identification Number (EIN / Tax ID)*

Ownership Information
Owner Name*
First Last
Ownership Percentage*
Please enter a number from 1 to 100.
Residential Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Owner Social*

Bank Information
Bank Name*
Routing / ABA Number*
9 digits
Account / DDA Number*

Pre-Application

Step 1 of 3

Ownership Information

Bank Information