Sign Up Now If you are a human and are seeing this field, please leave it blank. Business Information Business Name (DBA) Legal Name Federal Tax ID /EIN Company Type Sole Proprietor Partnership LLC/LLP C Corp Govt. (Local/State/Fed) 501c/Tax Exempt Prior Security Breach? Prior Bankruptcies? None Personal Business Business Location Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Phone Owner/Partner/Officer 1 Information Name Title Home Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Email Phone Date of Birth Percent of Ownership Owner Since All submitted data is encrypted with HTTPS. If you do not feel comfortable submitting your SSN, it can be collected when the application is signed. SSN Owner/Partner/Officer 2 Information Name Title Home Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Email Phone Date of Birth Percent of Ownership Owner Since All submitted data is encrypted with HTTPS. If you do not feel comfortable submitting your SSN, it can be collected when the application is signed. SSN Transaction Information Monthly Card Volume Average Card Ticket Highest Card Ticket Sales Breakdown Please enter the percentage of sales which are to consumers, businesses, and the government. The total of all three fields should equal 100%. Consumer Sales Business Sales Government Sales Total Percentage: 0.00% Transaction Types Please enter the percentage of card transactions which are swiped, keyed, online, or mail order/telephone order (MOTO). The total should equal 100%. Card Present Swiped Card Present Keyed MOTO Internet Total Percentage: 0.00% Final Steps Almost done! Describe Your Products and Services: Days to Delivery of Product or Service? What is your return policy?
