Admin Client || Dee Karawadra

Created On May, 09 2023 11:00am ID #204 Back

Merchant (Business) DBA Name : Louisville Dental Associates

Business Legal Name : Louisville Dental Associates

Contact Name : Chloe Crimm

Contact Phone Number : 662-773-5544

Physical Address : 114 Vance St

City : LOUISVILLE

State : MS

Country : USA

Zip : 39339

Email Address : [email protected]

<?xml version="1.0"?>
<object>
  <sales_number>12232233</sales_number>
  <sales_office/>
  <sales_signing_rep/>
  <irs_tax_id_type/>
  <irs_tax_id_no/>
  <ownership_type/>
  <business_incorporated/>
  <business_description/>
  <mailing_address>114 Vance St</mailing_address>
  <mailing_city>LOUISVILLE</mailing_city>
  <mailing_state>MS</mailing_state>
  <mailing_zip>39339</mailing_zip>
  <business_phone>662-773-5544</business_phone>
  <contact_first_name>Chloe</contact_first_name>
  <contact_last_name>Crimm</contact_last_name>
  <contact_phone>662-773-5544</contact_phone>
  <location_address>114 Vance St</location_address>
  <location_city>LOUISVILLE</location_city>
  <location_state>MS</location_state>
  <location_zip>39339</location_zip>
  <avg_ticket_amount/>
  <ave_month_volume/>
  <bank_name>Regions</bank_name>
  <bank_transit_number>065305436</bank_transit_number>
  <bank_dda_no>0338974207</bank_dda_no>
  <gross_vs_net>Gross Settlement</gross_vs_net>
  <refund_policy>0</refund_policy>
  <owner1_first_name>George</owner1_first_name>
  <owner1_last_name>Faulk</owner1_last_name>
  <owner1_home_address>186 Faulk Rd</owner1_home_address>
  <owner1_home_city>Eupora</owner1_home_city>
  <owner1_home_state>MS</owner1_home_state>
  <owner1_home_zip>39744</owner1_home_zip>
  <owner1_home_phone>6625520062</owner1_home_phone>
  <owner1_title>Owner</owner1_title>
  <owner1_ownership_perc/>
  <owner1_dob>1963-02-03</owner1_dob>
  <owner1_social_securrity_no>587013763</owner1_social_securrity_no>
  <owner1_form_of_id>Drivers License</owner1_form_of_id>
  <owner1_number>800846061</owner1_number>
  <owner1_expired>2023-02-03</owner1_expired>
  <owner1_issuer_state>MS</owner1_issuer_state>
  <owner1_issued_date>2015-01-12</owner1_issued_date>
</object>

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