Apply for Credit Card Processing Name * First Name Last Name Your Phone Number i.e. (555) 555-5555 (###) ### #### Business Email * Legal Business Name Entity Type * Do you have an incorporation or LLC I have an LLC I have an Incorporation I don't have either If yes, what is your EIN? Federal Tax ID# What is your DBA? * What do customers know you as? Does your business have a physical location? * Do you have a store front or an office? Yes No, I am online only No, I offer mobile services If yes, what is the address? What is your business mailing address? * Where should any paperwork be mailed to? Business Phone i.e. (555) 555-5555 or (800) 222-3333 (###) ### #### Does your business have a website? * i.e. www.walmart.com Yes Yes, but my website needs work No No, but I need a website What bank do you want your sales deposited to? * i.e. Chase Bank Chase Bank Capital One Bank Regions Bank Iberia Bank Navy Federal Credit Union USAA Federal Credit Union Liberty Bank Gulf Coast Bank First Horizon Bank of America Wells Fargo Other Is this a Business Account? * Yes No, it is a personal account Bank Routing Number * Bank Account Number * Do you own the business? * Yes No If no, do you have the owner's permission to submit this application? Yes No Owner's Name (if you are not the owner) First Name Last Name Owner's Phone Number (if you are not the owner) (###) ### #### Owner's Email (if different from the business email) Owner's Date of Birth * MM DD YYYY Owner's Social Security Number * Describe the business * Do you confirm that all the information submitted above is true and valid? * Yes No We have received your submission. Once processed we will reach out to you with an update.