Merchant Account Application
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Step One - Merchant Information
Do you wish to add
Discover Card?
Yes
No
Do you wish to add
American Express?
Yes
No
*
Legal Corporate Name:
*
Business Name:
*
Business Location:
*
City, State, Zip Code:
*
Ownership Type:
Sole Proprietor
Partnership
Corporation
Limited Liability Corp
Non-Profit 503C Corp
*
Federal Tax ID:
*
Business Phone:
*
Business Fax:
*
E-mail Address:
*
Website Address:
*
Business Type:
Retail Storefront
Restaurant
Office
Outside Sales
Outside Service
Tradeshow
Telephone Sales
Mail Order Sales
Homebased
Other
*
Describe Products Sold:
*
Average Sale Price:
*
Monthly Credit Card Volume:
*
Business Start Date:
Step Two - Owner Information
*
Principal's Name:
*
Home Address:
*
City, State, Zip Code:
*
Years At This Residence:
*
Rent or Own Residence:
Rent
Own Residence
*
Home Phone:
*
Cell Phone:
*
Title:
Owner
Partner
President
Vice-Pres
LLC Member
*
Ownership Equity %:
100% Ownership
50% Ownership
UNDER 50% Ownership
*
Social Security Number:
*
Drivers License Number:
*
Years in This Business:
