This information is used solely for the purpose of acquiring your Business License, and for applying for your Merchant Application. We do not store or keep this information. 

Bank Name
Social Security Number and (and EIN if they have one)
Business/Corporate Name as appears on Business License? This is different than the DBA, this will be the individual’s name on a sole proprietorship
Social Security Number or EIN Number
Driver's License Number
Driver's License State Issued
Driver's License Expiration Date
Business Formation (Sole-Proprietor, LLC, S-Corp, ect.)
Date of Birth
What is the address where you will be operating? Please include City, State and ZIP
Is the business location a home address or business address?
If you are starting a home based business, do you own your home?
If you don't own your home, what is the name, address and phone number of your landlord?
Driver's License Date Issued
Bank Address
Bank Phone Number
Checking Account Number
Bank Routing Number
Are you Providing a Credit Card or a Debit Card?
Card Number
Card Billing Address (if different from the address you already provided above)
CSV Code (3 digit code on the back of your card)
Card Expiration Date