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Business Information

In order to create your account we need to verify your business information. To prevent delays in activating your account please fill out the information below as accurately as possible.

Business Legal Name

To help us validate your business and match it with your Tax ID please enter the name exactly how it appears on your tax returns.

Business DBA Name

This is the name that will show up on your customers bank statements.

Tax ID

Business Type

Customer Service Phone Number

This is the phone number that will show up on your customers bank statements.

Website

www.

Please don't include www. or https://

Business Legal Address

Apt. #, Unit # etc. (optional)

City

State

Zip Code

Business Start Date

The year your business started.

Business Time Zone

Business Description

Revenue Estimates

Annual Credit/Debit Card Volume

Estimated annual credit card volume?

Annual ACH Volume

Estimated annual credit card volume?

Average Transaction

What is your average sale amount?

Largest Transaction

What is your largest single sale amount?

Beneficial Ownership

Federal regulation requires us to obtain and verify information about the beneficial owners of your business.

A beneficial owner is:

Anyone who owns directly or indirectly, 25 percent or more of the equity interests of your business and;
An individual with significant responsibility for managing the legal entity (this could be one of the owner(s) from above).

**To help us comply with the rule and verify the identity of the beneficial owners of your business please fill out the fields below with the most correct and up to date information as possible. If we are unable to verify your identity with the information provided below we may have to request additional information to help us comply with the rule which may delay the activation of your account.

How many people own 25% or more of the equity interests of your business?

Owner 1 Info

First Name	Last Name
Home Address (no P.O. box)	Apt. #, Unit # etc. (optional)
City	State
Postal Code	Date of Birth
Social Security Number	Ownership Percentage
Email Address	Personal Phone Number
OwnerOneSSN	Country
OwnerOneDOB	OwnerOnePhone

Owner 2 Info

First Name	Last Name
Home Address (no P.O. box)	Apt. #, Unit # etc. (optional)
City	State
Postal Code	Date of Birth
Social Security Number	Ownership Percentage
Email	Personal Phone Number
Country	OwnerTwoDOB
OwnerTwoSSN	OwnerTwoPhone

Owner 3 Info

First Name	Last Name
Home Address (no P.O. box)	Apt. #, Unit # etc. (optional)
City	State
Postal Code	Date of Birth
Social Security Number	Ownership Percentage
Email	Personal Phone Number
Country OwnerThreeSSN	OwnerThreeDOB OwnerThreePhone

Owner 4 Info

First Name	Last Name
Home Address (no P.O. box)	Apt. #, Unit # etc. (optional)
City	State
Postal Code	Date of Birth
Social Security Number	Ownership Percentage
Email	Personal Phone Number
Country	OwnerFourDOB
OwnerFourSSN	OwnerFourPhone

Managing Responsibility

In the case of a Sole Proprietor provide information for the owner. For Non-Profits, Government Agencies provide the information for an authorized signatory with significant responsibility to control, manage or direct the business.

Managing Responsibility

Provide information for someone with significant responsibility to control, manage or direct the business. If appropriate, an individual listed as a Beneficial Owner may be listed in this section.

Individual With Significant Control

First Name	Last Name
Home Address (no P.O. box)	Apt. #, Unit # etc. (optional)
City	State
Postal Code	Date of Birth
Title	Social Security Number
Email	Contact Phone Number
Address Country ControlPersonDOB	ControlPhoneNumber ControlPersonSSN

Bank Information

Tell us where we should deposit your funds.

Bank Name

Name on Account

Bank Account Number

Bank Routing Number

Account Type

CheckingSavings

Merchant Processing Agreement

I agree to the Terms and Conditions

Email Address of Signer:

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