Merchant Application

Streamline your online business and enhance the customer shopping experience with our user-friendly merchant application for your website.

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Business Information

Legal Business Name

DBA

Business Phone

Business Address

Address Line 1

City

State

Zip Code

Mailing Address

Address Line 1

City

State

Zip Code

Tax ID (EIN)

Dropdown

Types of Goods

Bank Name

Bank Routing Number

Bank Account Number

Owner Information

Owner Name

First

Last

Title

SSN

Date of Birth

Home Address

Address Line 1

City

State

Zip Code

Cell Phone

Driver License

Date

Signature

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