Merchant Services Application and AgreementMerchant Services Application and Agreement • April 8th, 2011 • Texas
BUSINESS FORMATION DOCUMENTS (DBA, ARTICLES OF INCORPORATION, ETC) THE FOLLOWING ADDITIONAL DOCUMENTATION MAY BE REQUIRED:
Merchant Services Application and AgreementMerchant Services Application and Agreement • July 28th, 2006
MERCHANT INFORMATION DBA NAME/OUTLET NAME: LEGAL NAME (IF DIFFERENT THAN DBA): PHYSICAL STREET ADDRESS (NO P.O. BOX): LEGAL ADDRESS: CITY, STATE, ZIP: CITY, STATE, ZIP: DBA PHONE: FAX: CORP. PHONE: FAX: CONTACT NAME AT THIS ADDRESS: E-MAIL: CONTACT NAME AT THIS ADDRESS: E-MAIL: CUSTOMER SERVICE PHONE # (REQUIRED FOR ALL MERCHANTS): WEB SITE ADDRESS (REQUIRED FOR INTERNET MERCHANTS):
PLEASE REMIT APPLICATION TO: (OVERNIGHT DELIVERY RECOMMENDED)Merchant Services Application and Agreement • June 7th, 2010 • Texas
MERCHANT INFORMATION DBA / OUTLET NAME CORPORATE NAME (IF DIFFERENT THAN DBA): PHYSICAL STREET ADDRESS: (NO P.O. BOXES) ADDRESS: CITY STATE ZIP CITY STATE ZIP PHONE: FAX: PHONE: FAX: CUSTOMER SERVICE PHONE NUMBER (REQUIRED FOR ALL MERCHANTS) WEB SITE ADDRESS: (REQUIRED FOR INTERNET MERCHANTS)
MERCHANT SERVICES APPLICATION AND AGREEMENTMerchant Services Application and Agreement • July 12th, 2013 • Nevada
GENERAL BUSINESS INFORMATION Merchant Name (DBA or Trade Name): Corporate/Legal Name (if different): Physical/Location Address: Corporate Address (if different): City: State: Zip: City: State: Zip: Business Telephone: Business Facsimile: Website: Date Business Formed: Years in Business: Months: Start-Up/New Company Federal Tax ID (or SSN if an individual): Number of Locations: Contact Name: Contact Email: Contact Telephone: Contact Facsimile: TYPE OF BUSINESS Sole Proprietorship Corporation (Attach Articles) LLC (Attach Articles) Partnership Publicly Traded -- Stock Symbol: Government Entity (Attach Articles & Tax Determination Letter) Non-Profit (Attach Articles & Tax Determination Letter) Foreign Entity -- Describe: Domestic Registration Yes No If Yes, State: Other: Are you a Franchisee? Yes No If Yes, Franchise Name That Will Be Utilized (Please Attach Franchise Agreement): OWNERSHIP (If a Privately Held Entity - Must Meet or Exceed 51% Ownership) (If a Non-Profit, Publicly Tr
Merchant Services Application and AgreementMerchant Services Application and Agreement • December 27th, 2023
MERCHANT INFORMATION DBA / OUTLET NAME CORPORATE NAME (IF DIFFERENT THAN DBA): PHYSlcAL STREET ADDRESS: (NO P.O. BOXES) ADDRESS: CITY STATE ZIP CITY STATE ZIP PHONE: FAX: PHONE: FAX: CUSTOMER SERVICE PHONE NUMBER (REQUIRED FOR ALL MERCHANTS) WEB SITE ADDRESS: (REQUIRED FOR INTERNET MERCHANTS)
