Application formCOMPANY INFORMATIONLegal Name of Business: Legal Address*:Address CityStateZip CodeBusiness Email:Customer Svc Phone:DBA Name:Website URL:DBA Address**:Address Line 1CityStateZip CodeDBA Phone:Fed Tax ID:Business Start Date:(Please Check One) Type of Corporation Sole Proprietorship Partnership LLC Corporation Non-Profit Currently Accept Credit Cards Yes No*Address Registered w/ Secretary of State **Location of Business OperationsAddress 2Address CityStateZip CodeOWNERSHIP INFORMATIONFirst Owner Name:First Owner EmailDOBSSN% of Ownership*:AddressAddressCityStateZip CodeOwner Phone:Title:*Info Required for ALL 25%+ OwnersSecond Owner Name:Second Owner EmailSecond Owner DOBSecond Owner SSNSecond Owner % of Ownership*:Second Owner AddressAddressCityStateZip CodeSecond Owner Phone:Second Owner Title:*Info Required for ALL 25%+ OwnersThird Owner Name:Third Owner EmailThird Owner DOBThird Owner SSNThird Owner % of Ownership*:Third Owner AddressAddressCityStateZip CodeThird Owner Phone:Third Owner Title:*Info Required for ALL 25%+ OwnersCREDIT CARD PROCESSING INFORMATIONCard Present %:Card Not Present %:PIN DEBIT: Yes NoInternet %:Max High End Ticket:B2B %:Average Ticket:Personal Guarantor: Yes NoProducts/Services Sold:Return/Refund Policy: Bank Name: Routing #:Account #:EQUIPMENT INFORMATIONTerminal (Make/Model):Gateway / Virtual Terminal (if applicable):Purchase New:Terminal Cost (if new): $EBT: Yes No Cost (if yes): Batch: (Check One) Auto ManualAuto-Batch Time:ATTACHMENTS TO BE SUBMITTED WITH THIS APPLICATIONVOIDED CHECK (REQUIRED)File Upload DRIVER’S LICENSE (REQUIRED)File Upload AGENTSubmitted By:Submit Your Application