Get Started

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Owner

Name

Percentage of Ownership

Corporate Name

DBA Name

DBA Address

Mailing Address

Phone

Email *

Date Business Established

What type of entity?

If LLC please enter which type?

Home Address

Mobile Phone

Date of Birth

Transaction Detail Average Sale, Total Monthly, Largest Sale

Transaction Detail Card Present %, Card Not Present %, Internet % ( must = 100%)

What types of goods do you sell?



Second Owner

2nd Owner Name

Percentage of Ownership

Home Address

Email *

Phone

Date of Birth



Upload Files

Signage Page

Voided Check

Upload ID