Personal Information Form

The information that you provide below is solely used for the purpose of acquiring your Business License, applying for your Merchant Account, and additional needed accounts when necessary. We do not store or keep this information.

Personal Information Form

First Name

Phone

What is your phone carrier?

Business/Corporate Name as it will appear on licenses

What is the address where you will be operating? (Include City, Sate and Zip)

Is the business location a home address or business address?

If a home address, do you own your home?

If you do not own your home, what i your landlord's name, address adnd phone number?

If you do own your home, how long have you lived there?

Do you have an Apple ID? If so, list ID/Password below.

Date of Birth

Social Security Number

EIN (If you already own a business)

Business Structure (Sole Proprietorship, LLC, etc.). Keep in mind that we do not form corporations for our clients, but will provide assistance.

Drivers License Number

Driver's License State Issued

Driver's License Date Issued

Driver's License Expiration Date

Bank Name

Bank Address

Bank Phone Number

Bank Routing Number

Is this a personal or business bank account?

What is the name listed on this bank account?

Thanks for submitting!

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Personal Information Form

Personal Information Form