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Point of Sales Solutions For Retailers & Merchants

apply for the prepaid/bill payment center
 
Thank you for your interest in becoming one of our merchant partners.

Below is a preliminary application that we require our potential merchant partners to complete. This is not the actual authorization document(s).

Before you complete this application please note that you will be required to provide the following information on the documents that we will send to you very soon:

-Your Employer Identification Number (EIN) and or
-The Social Security Number of the owner(s)
-The business address and the home address of the owner(s)
 

Also, you will be required to submit to us a Void Check in order for us to transfer funds from your account.

Please proceed in filling out the below application if you are comfortable in providing this information to us.
 

preliminary application

 
LEGAL BUSINESS NAME
DBA NAME (if different from legal name)
BUSINESS OWNER(S) NAME(S)
BUSINESS ADDRESS
CITY
STATE
ZIP
BUSINESS DESCRIPTION
NUMBER OF LOCATIONS
BUSINESS TELEPHONE#
BUSINESS FAX#
BUSINESS EMAIL
YEARS IN BUSINESS
HOW DID YOU HERE ABOUT US?
HOW IS YOUR BUSINESS OWNERSHIP ORGANIZED? (please select one box)
IF YOUR BUSINESS IS A CORPORATION, WHAT STATE AND YEAR WAS YOUR BUSINESS INCORPORATED?
STATE YEAR

 
 
           
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