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New Merchant Signup Form
Name of Business Owner
*
Business Name (D.B.A Name)
*
Legal Name
*
Contact Number (Business)
*
Contact Number (Personal)
Street Address
*
Apartment, suite, etc
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Email Address
*
Website
EIN Number
*
SSN Number
*
Proof of Business Registration
*
(Business License / Certificate of Incorporation)
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Void Check
*
Please upload a voided check
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Government-Issued Photo ID
*
Driving License or any valid identity document
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FNS Number
only if EBT service is required
Additional Supporting Documents
(if requested by your sales agent)
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