Application "*" indicates required fields Merchant InformationBusiness Legal Name* Business DBA Name (If Applicable) Federal Tax ID* Business Start Date* Business Address* City* State* ZIP* Mailing Address* City* State* ZIP* Contact Name Business Type* LLC Sole Proprietor Corporations S Corporations PhoneBuilding Type Location Email* Owner's Name & Title* Owner's Address* City* ZIP* Owner's DOB Owner's Social DL# Owner's Percent of Ownership of Business Monthly Volume $ Average Ticket $ High Ticket $ Currently Processing ? If "Yes", please provide most recent processing statement. Transaction Type (Retail Swiped, Mail-order/Telephone-order, or eCommerce): Swipe % Keyed % Internet % Website (If Applicable) What payment gateway, point-of-sale, or terminal is used to process payments? Cash Discount Yes No Rate Tran Fee EBT # Monthly Fee $ Terminal Ship To: Batch Close Disclaimer: Applicant authorize Swipe1 its Assigns, Agents, Banks of Financial Institutions to obtain an investigative or consumer report from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from applicant. Applicant, b signing below, represents that all the information is complete and accurate.Signature Reset signature Signature locked. Reset to sign again
