CC APP Form

Select Your Package

PACKAGE

PROMOCODE

Business Information

DBA NAME

LEGAL BUSINESS NAME

BUSINESS TELEPHONE

EMAIL ADDRESS

WEBSITE ADDRESS

BRIEF BUSINESS DESCRIPTION

NEW OR EXISTING BUSINESS?

NewExisting

SETUP TYPE

In personIn person with a tip line on the receiptInternetMail-Oder / Phone-Order

PHYSICAL BUSINESS ADDRESS

TOTAL ANNUAL SALES

ANNUAL CREDIT/DEBIT CARD SALES

AVERAGE TRANSACTION AMOUNT

HIGHEST TRANSACTION AMOUNT

SWIPE %

KEYED %

INTERNET %

OWNERSHIP TYPE

FEDERAL TAX ID

BUSINESS START DATE

BANK ROUTING NUMBER

BANK NAME

BANK ACCOUNT NUMBER

PROOF OF BUSINESS

CURRENT PROCESSING STATEMENT

ATTACH AN IMAGE OF A VOIDED BUSINESS CHECK

CARD ACCEPTANCE
Visa/MC/DiscoverAmex

Owner Information

OWNER'S NAME

s

HOME ADDRESS

OWNER'S HOME PHONE NUMBER

OWNER'S SSN

OWNER'S DATE OF BIRTH

IS THERE A 2ND OWNER

YesNo

Equipment and Membership Agreement

DO YOU NEED NEW EQUIPMENT FROM US OR WILL WE REPROGRAMMING EXISTING EQUIPMENT?

NewReprogramUnsure

Select Your Package

Business Information

Owner Information

Equipment and Membership Agreement

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Business Hours

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Vacations :

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