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MERCHANT CREDIT CARD PROCESSING AGREEMENT - PAGE 1 OF 5
Georgia • July 30th, 2008
  • Jurisdiction
  • Filed
    July 30th, 2008

BUSINESS INFORMATION Business LEGAL Name: Taxpayer Identification Number (TIN): (9 digits) IMPORTANT: To avoid disruption of service or potential financial consequences please ensure that the Business Legal Name and TIN (Taxpayer Identification Number) you are providing on this application exactly match the information you have on file, or will file, with the Internal Revenue Service for this business. Email Address (Required): Business DBA Name ( if different than legal name): Business LEGAL Address: Business Physical Address (if different than legal address): City, State, Zip: City, State, Zip: Main Contact: (First Name) (M.I.) (Last Name) Business Phone Number: Alternate Contact Phone Number: Number of Locations: Current Ownership Length: Year(s) Month(s) FAX Number: Mobile / Cell Phone (if applicable): OWNERSHIP INFORMATION Owner #1 / Partner / Officer #1: (First Name) (M.I.) (Last Name) Social Security #: Ownership Percentage Phone Number: Title in Business: Date of Birth: U.S. Ci

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