Merchant Pre-Application Step 1 of 6 Agent Information Please provide the agent information for this request. Agent Name * Agent Email * Agent Phone * Request Type * New Merchant Adding an Additional Location Ownership Change Next Contact & Address This is not necessarily the signatory, but it is the main person to contact regarding this merchant account. Primary Contact Name * Business Phone * Contact Email * Business Street Address * City * State * Zip * Back Next Business Identity Legal Name * DBA Name (If different from legal) Federal Tax ID # (EIN) * Tax Filing Type * Select… GOV Sole Proprietor LLC Non-Profit Partnership Priv. Corp. Public Corp Tax Exempt Business Description / Type * Back Next Signor Details Signor Name * Ownership Percentage * SSN (optional) Title * Select… Pres. VP Member LLC Secretary Treasurer CEO CFO COO Signor Street Address * City * State * Zip * Signor Email Back Next Banking Details Checking account only. (Optional at pre-app stage.) Bank Name Bank Routing # Bank Account # Back Next Account Setup Monthly Credit Card Volume ? Average Ticket Amount * ? High Ticket Amount ? Mode of Transaction (must total 100%) * In Person % * Keyed In % * Notes I confirm the above information is accurate. * Back Submit Thanks! Your pre-application has been submitted successfully.
