{{-- Step 2: Business Information (mega-form: business + processing + addresses + bank accounts) --}} {{-- ── Basic Business Info ── --}}

Basic Business Information

DBA Name *

Website Address *

Legal Name *

Merchant Customer Service Number *

Is it an existing business? *

Yes

Years in Business *

DBA Information

Phone Number *

Contact First Name *

Email Address *

Contact Last Name *

Contact Title *

Address

Street Address *

Postal Code *

City *

Unit, Suite, etc.

State *

Country *

Legal Information

The same as DBA Information

Phone Number *

Contact First Name *

Email Address *

Contact Last Name *

Contact Title *

Address

Street Address *

Postal Code *

City *

Unit, Suite, etc.

State *

Country *

Chargeback and Mailing/Billing

Chargeback Information

The same as DBA Information

Phone Number *

Contact First Name *

Contact Last Name *

Contact Title *

Address

Street Address *

Postal Code *

City *

Unit, Suite, etc.

State *

Country *

Chargeback Notification *

Fax

Email Address *

Mailing/Billing Information

The same as DBA Information

Phone Number *

Contact First Name *

Email Address *

Contact Last Name *

Contact Title *

Address

Street Address *

Postal Code *

City *

Unit, Suite, etc.

State *

Country *

Opt out of Electronic Statement? *

Yes

Business Description

Ownership Type *

Business Type *

Tax Exempt?

Yes

Charity 501(c)(3) Exempt

MCC / SIC Code *

Tax ID Type *

Tax ID *

Merchant Description / Goods & Services Sold *

Banking Information

Minimum one bank account is required.

Processing Information

Average Ticket *

Monthly Volume *

Highest Ticket *

Card Types Requested *

Business to Business %

Transaction Mix * — must total 100%

Card Present %

eCommerce %

Manually Keyed / MOTO %

TOTAL: 0%

Partial Auth Required

Additional Information

Patriot Act — Business Verification

Please provide one of the following documents to verify the business entity:

Government Issued Business License

Tax Return

Articles of Incorporation

Business Financial Statement

State of Issuance *

Date of Issuance *

Expiration Date *

Site Survey

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