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1 Lowercase letter
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Business Information

In order to create your account we need to collect and verify your business information.

To help us activate your account as soon as possible 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 Address (No PO Boxes)

Apt. #, Unit # etc. (optional)

City

State

Zip Code

What Year Did Your Business Start?

The year your business started.

Business Time Zone

Business Description

Revenue Estimates

Annual Credit/Debit Card Volume

Please estimate your annual credit card sales volume.

Annual ACH Volume

Please estimate your annual ACH sales volume.

Average Transaction

What is your average sale amount?

Largest Transaction

What is your largest single sale amount?

Beneficial Ownership

How many people own, directly or indirectly, 25% or more of the business?

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).

Beneficial Owner 1 Info

First Name

Last Name

Ownership Percentage

Home Address (no P.O. box)

Apt. #, Unit # etc. (optional)

City

State

Postal Code

Date of Birth

Social Security Number

Email Address

Personal Phone Number

Country

OwnerOneSSN

OwnerOneDOB

OwnerOnePhone

Beneficial Owner 2 Info

First Name

Last Name

Ownership Percentage

Home Address (no P.O. box)

Apt. #, Unit # etc. (optional)

City

State

Postal Code

Date of Birth

Social Security Number

Personal Phone Number

Country

OwnerTwoDOB

OwnerTwoSSN

OwnerTwoPhone

Beneficial Owner 3 Info

First Name

Last Name

Ownership Percentage

Home Address (no P.O. box)

Apt. #, Unit # etc. (optional)

City

State

Postal Code

Date of Birth

Social Security Number

Personal Phone Number

Country

OwnerThreeSSN

OwnerThreeDOB

OwnerThreePhone

Beneficial Owner 4 Info

First Name

Last Name

Ownership Percentage

Home Address (no P.O. box)

Apt. #, Unit # etc. (optional)

City

State

Postal Code

Date of Birth

Social Security Number

Personal Phone Number

OwnerFourDOB

Country

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

Title

Home Address (no P.O. box)

Apt. #, Unit # etc. (optional)

City

State

Postal Code

Date of Birth

Social Security Number

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

9 digit routing number

check

Account Type

CheckingSavings

deposit.bankName

Holder Name

Merchant Processing Agreement

Please review and agree to our terms and conditions to finalize your account registration.

I agree to the terms and conditions

Email Address of Signer:

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