Merchant Information Sheet

Business Information
Your business legal name*
Your business name (DBA)*
Business Classification*
Business Type*
Contact Person*
First Last
Title / Position*
Email address*
Business Location Address*
Street Address Address Line 2 City State ZIP Code
Business Location Type*
Business Phone Number*
Business Fax Number
Your Business Website Address
Date your business opened*
MM
DD
YYYY
Federal Tax ID number*
Does more than one person own 25 percent of the business?*
Beneficial Ownership is a new rule from the Financial Crimes Enforcement Network (FinCEN), under the Bank Secrecy Act, which requires all covered financial institutions to collect and verify specific information about the beneficial owners of the entity at the time a new account.
1) Control Owner / Officer / Principal Name
Ownership Percentage*
Please enter a number from 0 to 100.
Full Name*
First Last
Title / Position
Date of Birth*
MM
DD
YYYY
Owner since (MM / YY)*
Social Security #
Phone*
Residence address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
2) Beneficial Owner / Officer / Principal Name
Ownership Percentage*
Please enter a number from 0 to 100.
Full Name
First Last
Title / Position
Date of Birth
MM
DD
YYYY
Owner since (MM / YY)
Social Security #
Phone
Residence address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
3) Beneficial Owner / Officer / Principal Name
Ownership Percentage*
Please enter a number from 0 to 100.
Full Name
First Last
Title / Position
Date of Birth
MM
DD
YYYY
Owner since (MM / YY)
Social Security #
Phone
Residence address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
4) Beneficial Owner / Officer / Principal Name
Ownership Percentage*
Please enter a number from 0 to 100.
Full Name
First Last
Title / Position
Date of Birth
MM
DD
YYYY
Owner since (MM / YY)
Social Security #
Phone
Residence address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Banking Information
Deposit bank name*
Business checking account number*
Transit routing number / ABA*
Upload an image of a voided check
Upload an image of a voided check*
Your current credit card transcations
Note: If you currently do not process credit cards, please provide estimates below.
Annual Credit Card Volume*
Average Ticket*
Highest Ticket*
Do you have seasonality in your credit card acceptance?*
Please describe peak months and percentage increases
Swiped (credit card present)*
Keyed (credit card NOT present)*
E-commerce (online store)*
Percentage of Credit Cards Paid by a CONSUMER
Percentage of Credit Cards Paid by a BUSINESS
How do you ship the majority of your product orders?
Do you use a fulfillment house?
Does your fulfillment house have access to capture card numbers?
Fulfillment house name
Do you accept payments via website?
Refund Policy on credit card sales
Time Frame from transaction / delivery
% of order delivered
Enter percentage amount for your selection
Visa / MasterCard / Discover credit cards will be charged*
Please specify
Do you accept (or will you accept) American Express?*
Do you wish to accept Discover?*
Your AMEX Account (SE) #
Describe the product or service that your company will be providing that will initiate the acceptance of credit card, debit card or ACH transactions. If you accept credit cards for varying product/services, please describe the percentage of total volumes per product/service.
Upload last month's credit card statement
Drop files here or

Your information will stay private and secure.

Business Information

1) Control Owner / Officer / Principal Name

2) Beneficial Owner / Officer / Principal Name

3) Beneficial Owner / Officer / Principal Name

4) Beneficial Owner / Officer / Principal Name

Banking Information

Your current credit card transcations

Time Frame from transaction / delivery