Merchant Application Form Business Information Business Name* Business Address* State* City* ZIP Code* EIN Number* Customer Service Phone Website Owners/Contact Information Full Name* Country* State* City* Zip Code* Address* Phone Number* Email Address* Date of Birth* Percentage of Ownership* SSN* Financial Information Average Monthly Sales Volume* Average Ticket* (Average ticket amount is the average dollar amount per transaction) Highest Ticket* (Dollar amount of the highest sale possible for your business. If the amount varies and does not have a capped limit, please fill out the highest sale amount from the past 3 months) Owners Identification Identification Document* Document Number* Issuing Country (if applicable) Issuing State (if applicable) Issue Date* Expiry Date* Settlement Information Deposit Bank Name* ABA/Routing* Account Number
