Pre-app Cover Details
Created On
Jan, 01 1970 00:00am
ID #
Pre-app Cover Details
Attached
Required Document Checklist :
-
Merchant
(Business) DBA Name :
-
Business Legal Name :
-
Contact Name :
-
Contact Phone Number :
-
Physical
Address :
-
City :
-
State :
-
Country :
-
Zip :
-
Phone Number :
-
Fax Number :
-
Email Address :
-
Website :
-
Billing Address
Address :
-
City :
-
State :
-
Country :
-
Zip :
-
Business Type
State incorporated in :
Public
Type of Legal Entity :
-
Business Type :
-
Business Start Date :
-
EIN/Federal Tax ID Type :
-
EIN/Federal Tax ID# :
-
Types of Goods Sold :
-
Ownership Information
Owner 1
Officer/Owners Name:
Marla Mounce
Title :
Vice Mayor
Social Security:
546-74-1059
Home Address:
23660 Hwy 57
City :
LaGrange
State:
TN
Country:
Zip:
38046
Drivers License:
144179986
Issue Date:
Oct, 18 2021
Expiration Date:
Aug, 27 2028
State:
TN
DOB:
Apr, 17 1961
Home Phone Number:
% of Business Owned :
0
Length of Ownership :
Banking Information
Billing Type :
-
Name of Bank :
-
ABA Routing :
-
Account :
-
Estimated Sales Volume
Estimated Annual Sales Visa/MC/Discover/ AMEX Sales :
-
Estimated Monthly Visa/MC/Discover/ AMEX Sales :
-
Average Ticket :
-
High Ticket :
-
Business Profile
Card Swiped :
-
Card Keyed In :
- =
0%
Card Present :
-
Card Not Present :
- =
0%
Moto :
-
Internet :
-
-
Notes :
-
Terminal Answer
Batch Out Time :
-
Terminal Type :
-
Communication Method :
-
Do You Dial 9 For Outside Line? :
-
Reprogram Terminal :
-
Equipment Purchase :
-
Equipment Rental Program :
-
Next Day Funding :
-
Tip Edit :
-
EBT :
-
FNS Number :
-
Tax Calculation :
-
If So Tax Rate :
-
Refund Policy :
-
Print Refund Policy On Footer :
-
Software Or POS Integration Answer
POS Software Integration :
-
Software Name & Version :
-
MP/AP Name :
-
RP Name :
-
Pricing Provided :
-
Receipt Header Message :
-
Receipt Footer Message :
-