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Pre-Application Form

Legal Business Name *

Type of Ownership

Sole Proprietor PartnershipCorporationLLC/LLPNon-Profit

Tax ID Number *

Date Business Started *

DBA Organization Name *

DBA Organization Address *

DBA City *

DBA State *

DBA Zip *

Product/Service Sold *

Legal Address *

Legal City *

Legal State *

Legal Zip *

Owner Full Name *

Owner's Date of Birth *

Owner's Social Security # *

Point of Contact Name *

Point of Contact Phone # *

Point of Contact Email Address *

Bank Name *

Bank Routing Number *

Bank Account Number *

Are currently accepting credit cards? * Select OneYesNo

If yes, then who are you processing with?

Current or estimated monthly volume? *

Average transaction amount? *

What would be a high transaction amount? *

How often does a high transaction occur?

How did you hear about us?

Best time to reach you to review your application?

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