Pre-Application Form

Personal Information

First Name *

Last Name *

Phone *

Email *

Social Security Number *

Equity Ownership % *

Driver's License Number *

Issuing State *

Copy of your Drivers License (KYC check) *

Date of Birth (m/d/y) *

Business Information

Legal Name of Business *

DBA

Time in Business *

Products Sold *

Address

Street Address

City

State

Postal code

Business Telephone *

Federal Tax ID (EIN) *

Bank Account Name *

Account Number *

Routing Number *

Contact Person Name *

Contact Telephone Number *

Contact Person Email Address *

Website *

Monthly Volume *

Average Transaction Amount *

High Ticket Amount *

Current Provider *

Copy of a Voided Check (or signed bank form) *

Company Articles *

Bank Statements for last 2-3 months *

Present Processor Statement for last month (showing volume and amount per transactions) *

Referred By

By checking the box, you agree to the following:

You consent to be contacted by our team via email, phone, or other communication methods provided in this form.
You agree to receive additional information about our credit card processing services.
You acknowledge that the information you provide is accurate and complete to the best of your knowledge.
You understand that your consent is required to proceed with the pre-application process.
I consent to receive transactional messages related to my account or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others.
Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out or by emailing [email protected]

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