Call us now at 1-855-933-3729, or fill out the application below and one of our agents will contact you as soon as possible. Call us now at (844) 44-MARY-J, or fill out the application below and one of our agents will contact you as soon as possible. ISO 213 Call us now at (844) 44-MARY-J, or fill out the application below and one of our agents will contact you as soon as possible. ISO 213 Call us now at (844) 44-MARY-J, or fill out the application below and one of our agents will contact you as soon as possible. ISO 213 Call us now at (844) 44-MARY-J, or fill out the application below and one of our agents will contact you as soon as possible. ISO 213 Call us now at (800) 372-4950, or fill out the application below and one of our agents will contact you as soon as possible. ISO 204 Call us now at (919) 264-7464, or fill out the application below and one of our agents will contact you as soon as possible. ISO 211 ISO 221 Banking Application Upon submission, a confirmation email will be sent to the Business Email Address that you enter. If you need to save your entries and continue later, scroll to the bottom of this page and click the "Save and Continue Later" link.Agent's NameBusiness InformationLegal Business Name * RequiredDBA NameType of BusinessFederal Tax IDOrganization TypePlease Select...CorporationLLCSole ProprietorshipOtherAddress * RequiredCity * RequiredState * RequiredPlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP * RequiredBilling Address (if different)Billing CityBilling StatePlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBilling ZIPPhone at LocationPreferred PhoneFaxBusiness Email (no longer used)Business Email Address * Required Website URLYears in BusinessFinancial InformationAverage Ticket PriceAverage Monthly V/MCAverage Monthly AMEXGross Annual SalesCurrent CC ProcessorOwner/Officer InformationIf there are more than 3 owners/officers, add them in the Additional Notes section near the bottom of this form.Number of Owners/Officers * Required123More than 3---- Owner/Officer 1 ----First Name * RequiredLast Name * RequiredDate of Birth * Required MM DD YYYY SSN * RequiredPercent of Ownership * RequiredHome Address * RequiredCity * RequiredState * RequiredPlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP * RequiredHome PhoneCell PhonePersonal Email Own or Rent Home?OwnRentYears ThereDrivers License NumberDrivers License StatePlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming---- Owner/Officer 2 ----First Name * RequiredLast Name * RequiredDate of Birth * Required MM DD YYYY SSN * RequiredPercent of Ownership * RequiredHome Address * RequiredCity * RequiredState * RequiredPlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP * RequiredHome PhoneCell PhonePersonal Email Own or Rent Home?OwnRentYears ThereDrivers License NumberDrivers License StatePlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming---- Owner/Officer 3 ----First Name * RequiredLast Name * RequiredDate of Birth * Required MM DD YYYY SSN * RequiredPercent of Ownership * RequiredHome Address * RequiredCity * RequiredState * RequiredPlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP * RequiredHome PhoneCell PhonePersonal Email Own or Rent Home?OwnRentYears ThereDrivers License NumberDrivers License StatePlease Select...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBusiness LocationLease or Own?LeaseOwnTerm on LeaseMonthly Rent/MortgageLandlord or Mortgage CoLandlord Contact NameContact Work Phone #Landlord Contact Cell #Landlord Contact Email ReferencesBank Name & BranchBank Contact NameBank Contact Phone #Trade Reference 1 NameTrade Reference 1 ContactTrade Reference 1 Phone #Trade Reference 2 NameTrade Reference 2 ContactTrade Reference 2 Phone #Trade Reference 3 NameTrade Reference 3 ContactTrade Reference 3 Phone #OtherAre there any pending, threatened or recently filed claims judgments or liens? * RequiredYesNoPlease explainAre you contemplating a bankruptcy filing? Reorganization? Sale of the Business? * RequiredYesNoPlease explainFunding OptionIf interested in funding, please fill out below:Need Funding ForAmount RequestedRequired FilesPlease upload the following documents: Articles of Incorporation EIN Letter / Number Government Issued Photo ID Voided Check 3 months merchant processing statements (IF AVAILABLE) The following limitations apply: Maximum total size: 40 MB Allowed file types: pdf, jpg, jpeg, gif, png Drop files here or Accepted file types: pdf, jpg, jpeg, gif, png. Maximum file size - 40 mega bytes. Additional NotesI hereby represent that all the above information is true and understand that making false statements might be considered fraud. By providing the above information, the applicant(s) authorize you to whom this application is made or your agents to investigate my/our financial responsibility and credit worthiness, specifically principal and corporate entities, and will provide financial statements, tax returns, etc. as you deem necessary. A photocopy of this authorization will be deemed as acceptable for release of credit information. I/we authorize Evergreen Gateway to receive pertinent information regarding the commercial lease for the above referenced location from my leasing company and or agent. I/we authorize you to update my/our credit profile from time to time in the future, as you deem appropriate.Signature 1 * RequiredSignature 2 * RequiredSignature 3 * RequiredNameThis field is for validation purposes and should be left unchanged.
