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 CBD PayFac 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. All items marked with an asterisk * are required.Agent's NameTell Us About Your BusinessMerchant Corporate Legal Name * RequiredMerchant Business Name (Doing Business As)Merchant Address * RequiredMerchant City * RequiredMerchant State * RequiredMerchant ZIP * RequiredBusiness Phone * RequiredBusiness FaxBusiness Email Address * Required Business Web AddressBusiness Contact Name * RequiredAdditional Business InformationBusiness Description (if it's a public company, you only need to provide the ticker symbol) * RequiredProducts/Services Sold * RequiredState IncorporatedMonth & Year Started * RequiredFederal Tax ID #Number of EmployeesOwnership Type * RequiredSole ProprietorshipPartnershipNon‐ProfitPublic CorporationPrivate CorporationLimited Liability CorporationMedical CorporationLegal CorporationGovernmentAssociation / Estate / Trust501c (please include your 501c documents)Yearly Sales VolumeAverage TicketHighest Ticket AmountEquipment TypeBank ABA #Bank DDA #Card Present? * RequiredYesNoPercentage of transactions that will be swiped * RequiredOwnership InformationIf there are more than 3 owners, add them in the Additional Notes section near the bottom of this form.Number of Owners * Required123More than 3Provide the following information for each individual who owns, directly or indirectly 20% or more of the equity interest of your business. If no owners have 25% ownership, list a managing director.---- Owner/Officer 1 ----Owner 1 Full Name * RequiredOwner 1 Drivers Lic # & StateOwner 1 Date of BirthOwner 1 SSNOwner 1 Ownership %Owner 1 Title / PositionOwner 1 AddressOwner 1 CityOwner 1 StateOwner 1 ZIP CodeOwner 1 Home/Cell Phone---- Owner/Officer 2 ----Owner 2 Full Name * RequiredOwner 2 Drivers Lic # & StateOwner 2 Date of BirthOwner 2 SSNOwner 2 Ownership %Owner 2 Title / PositionOwner 2 AddressOwner 2 CityOwner 2 StateOwner 2 ZIP CodeOwner 2 Home/Cell Phone---- Owner/Officer 3 ----Owner 3 Full Name * RequiredOwner 3 Drivers Lic # & StateOwner 3 Date of BirthOwner 3 SSNOwner 3 Ownership %Owner 3 Title / PositionOwner 3 AddressOwner 3 CityOwner 3 StateOwner 3 ZIP CodeOwner 3 Home/Cell PhoneFunding OptionIf interested in funding, please fill out below:Need Funding ForAmount RequestedRequired DocumentsPlease upload the following documents: Voided Check or Bank Letter EIN Letter Background information on principals – LinkedIn profile link, resume or bio Listing of key management – names & titles with LinkedIn profile link, resume or bio Corporate Overview, Investor Presentation, or Sales Presentation deck 2 years of fiscal year financial statements (Audited statements preferred but in house, CPA reviewed or tax returns may be acceptable). If public company, please provide ticker symbol and no need to provide actual financial statements Interim financial statements (most recent quarterly financial statements generally required if present date is more than 5 months past merchant’s fiscal year end). If public company, no need to provide. 3-year P&L projections (if merchant is a start-up or existing company operating at a loss) 3 Month's Merchant Processing Statements PayFac Contract CBD Requirements: **Topical Only** Cannabis Attestation CBD Checklist CBD Lab report(s) 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 NotesEmailThis field is for validation purposes and should be left unchanged.
