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 (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 Merchant Processing 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 Name Tell Us About Your BusinessMerchant Corporate Legal Name * Required Merchant Business Name (Doing Business As) Merchant Address * Required Merchant City * Required Merchant State * Required Merchant ZIP * Required Business Phone * Required Business Fax Business Email Address * Required Business Web Address Business Contact Name Products/Services Sold * Required Additional Business InformationState Incorporated Month & Year Started Federal Tax ID # Number of Employees Ownership Type * Required Sole Proprietorship Partnership Non‐Profit Public Corporation Private Corporation Limited Liability Corporation Medical Corporation Legal Corporation Government Association / Estate / Trust 501c (please include your 501c documents) Yearly Sales Volume Average Ticket Highest Ticket Amount Equipment Type Ownership InformationIf there are more than 3 owners, add them in the Additional Notes section near the bottom of this form.Number of Owners * Required 1 2 3 More than 3 Provide the following information for each individual who owns, directly or indirectly 25% 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 * Required Owner 1 Drivers Lic # & State Owner 1 Date of Birth Owner 1 SSN Owner 1 Ownership % Owner 1 Title Owner 1 Address Owner 1 City Owner 1 State Owner 1 ZIP Code Owner 1 Home/Cell Phone Owner 1 Email Address * Required ---- Owner/Officer 2 ----Owner 2 Full Name * Required Owner 2 Drivers Lic # & State Owner 2 Date of Birth Owner 2 SSN Owner 2 Ownership % Owner 2 Title Owner 2 Address Owner 2 City Owner 2 State Owner 2 ZIP Code Owner 2 Home/Cell Phone Owner 2 Email Address * Required ---- Owner/Officer 3 ----Owner 3 Full Name * Required Owner 3 Drivers Lic # & State Owner 3 Date of Birth Owner 3 SSN Owner 3 Ownership % Owner 3 Title Owner 3 Address Owner 3 City Owner 3 State Owner 3 ZIP Code Owner 3 Home/Cell Phone Owner 3 Email Address * Required Funding OptionIf interested in funding, please fill out below:Need Funding For Amount Requested Required DocumentsPlease upload the following documents: Articles of Incorporation EIN Letter / Number Government Issued Photo ID Voided Check Any state licenses your business is required to have 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 Select files Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 40 MB. Maximum file size - 40 mega bytes. Additional NotesNameThis field is for validation purposes and should be left unchanged.
