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First Name
Last Name
Legal Business Name
Doining Business As(Name)
Email Address
Phone Number
Customer Service Number
Application Type
Credit Card
E-Check Processing
Industry Type
Primary Method of Accepting Credit Cards
Over the Phone
Secondary Method Of Accepting Credit Cards (If Any)
eCommerce
Expected Monthly Volume
Avg. Transaction Size
Max. Transaction Size
Has Your Company Had An Active Merchant Account In The Last 90 Days?
Yes
No
Current or Recent Merchant Account Provider
Business Website
Date Business Opened
Entity Type
LLC
C Crop
Sole Proprietor
Entity State
Bank Name
Bank Routing Number
Bank Account Number
Office Address
City
State
Zip Code
Office Sq. Footage
Home Address
City
State
Zip Code
Owner's Personal Phone Number
Date of Birth
Driver's License Number
Driver's License Expiration Date
Owner's Social Security Number
Approximate % Owned By Listed Owner
3 Months of Bank Statements
Picture of Driving license (front)
Picture of Driving license (back)
Picture of holding Driving License
EIN Letter
Letter of Incorporation
03 months of processing statements
Voided cheque or Bank letter
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