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 (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 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 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 NameProducts/Services Sold * RequiredAdditional Business InformationState IncorporatedMonth & Year StartedFederal 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 TypeOwnership 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 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 * RequiredOwner 1 Drivers Lic # & StateOwner 1 Date of BirthOwner 1 SSNOwner 1 Ownership %Owner 1 TitleOwner 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 TitleOwner 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 TitleOwner 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: Articles of Incorporation EIN Letter / Number Government Issued Photo ID Voided Check 3 months bank statements 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 NotesCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
