Basic Application Questions

What is your Legal Entity Name? *

Do you use a DBA? If so, what is the name?

Address

What is your Business Physical Address? *

City *

State *

Country *

Postal Code *

Business Mailing Address

What Date was your Business Established? *

What is your EIN# for your Business? *

Business Phone Number *

What is your Business Website? *

Name of person filing out this form

First Name *

Last Name *

Email *

Phone Number (Cell)

What is your Entity Type *

PROCESSING

How many Point of Sale devices does your business need?

What Types of Point of Sale equipment do you require? We will discuss all options and pricing with you. This is just a starting point. CHECK ALL THAT APPLY *

Full Point of Sale with Monitor, Cash Drawer, Receipt Printer - With Inventory Capabilities

Handheld with Receipt Printer. Used with WiFi or SIM card - With Inventory Capabilities

Card Reader Attachment for your phone or tablet - No inventory capabilities

I like what I have now and want to get something similar. - If selecting this box, please select a box above as well.

I don't like what I am using now and want to change to something better with more capabilities.

I am not sure what I need.

Other

If you selected "Other" to the last question, please elaborate.

What is your average transaction total per card transactions? *

$

What is your average monthly sales for credit card processing? *

$

What percentage of your transactions are swiped with card present? *

What percentage of your transactions are keyed in with card not present? *

What percentage of your credit card transactions are internet sales? *

Do you accept payments for other sellers on your website? *

If you answered "I DON'T SEE MINE LISTED HERE", please type yours below.

Is there a history of Bankruptcy? *

Have you have had your processing terminated or prior breach? *

What State did you start your business in? *

BENEFICIAL OWNERSHIP

PRIMARY BENEFICIAL OWNER INFO *

Full Name
Phone #
Email
Date of Birth
% Ownership
ARE YOU A US CITIZEN?
Social Security #
Drivers License #

What is the home address for the PRIMARY BENEFICIAL OWNER? *

Street Address
City
State
Postal Code

SECONDARY BENEFICIAL OWNER INFO - If there is no secondary owner please skip this section

Full Name
Phone #
Email
Date of Birth
% Ownership
ARE YOU A US CITIZEN?
Social Security #
Drivers License #

What is the home address for the SECONDARY OWNER?

Street Address
City
State
Postal Code

Owner Info *

After we start you processing would you also like to become a referring agent for to receive an additional 1/2% of processing revenue profits? *

WHERE TO SEND YOUR FUNDS?

Bank Information *

Bank Name
Routing Number
Account Number

NEXT STEPS

Please be aware submitting this application will create a "soft pull" of your credit. Please check the box that you understand this and agree. *

I understand that submitting this application will result in a soft pull of my credit. This is necessary to get approval from underwriting in order to move forward.

I do not agree and therefore please do not submit my application or proceed with this process.

BOARDING DOCS REQUESTED

Upon submitting this form, you'll be requested to email the following documents:

3 months Business Checking Account Statements

3 months Credit Card Processing Statement

Drivers License or Passport (Front/Back) of Beneficial Owner(s)

Please note: Depending on the type of business and length of business, further documentation may be requested at a later date by underwriting. If this happens, we will reach out to you to gather additional information.

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