Admin Client || Dee Karawadra

Created On Aug, 29 2024 13:49pm ID #7811 Back

Merchant (Business) DBA Name : Campos Family Dental

Business Legal Name : Campos Family Dental P.C.

Contact Name : Gregory J. Campos DMD

Contact Phone Number : 2178212562

Physical Address : 508 West Jefferson Avenue, Effingham, IL 62401, USA

City : Effingham

State : IL

Country : USA

Zip : 62401

Email Address : [email protected]

<?xml version="1.0"?>
<object>
  <sales_number>12232233</sales_number>
  <sales_office/>
  <sales_signing_rep/>
  <irs_tax_id_type>Employer Identification Number</irs_tax_id_type>
  <irs_tax_id_no>*****7294</irs_tax_id_no>
  <ownership_type>Private Corporation</ownership_type>
  <business_incorporated>Illinois (IL)</business_incorporated>
  <business_description>Dentist</business_description>
  <mailing_address>508 West Jefferson Avenue, Effingham, IL 62401, USA</mailing_address>
  <mailing_city>Effingham</mailing_city>
  <mailing_state>IL</mailing_state>
  <mailing_zip>62401</mailing_zip>
  <business_phone>2178212562</business_phone>
  <contact_first_name>Gregory</contact_first_name>
  <contact_last_name>J.</contact_last_name>
  <contact_phone>2178212562</contact_phone>
  <location_address>508 West Jefferson Avenue, Effingham, IL 62401, USA</location_address>
  <location_city>Effingham</location_city>
  <location_state>IL</location_state>
  <location_zip>62401</location_zip>
  <avg_ticket_amount>200</avg_ticket_amount>
  <ave_month_volume/>
  <bank_name>Crossroads Bank</bank_name>
  <bank_transit_number>081224122</bank_transit_number>
  <bank_dda_no>*****1491</bank_dda_no>
  <gross_vs_net>Gross Settlement</gross_vs_net>
  <refund_policy>3</refund_policy>
  <owner1_first_name>Gregory</owner1_first_name>
  <owner1_last_name>J.</owner1_last_name>
  <owner1_home_address/>
  <owner1_home_city>EFFINGHAM</owner1_home_city>
  <owner1_home_state>IL</owner1_home_state>
  <owner1_home_zip>62401</owner1_home_zip>
  <owner1_home_phone>2178212562</owner1_home_phone>
  <owner1_title>Owner / Dr</owner1_title>
  <owner1_ownership_perc>100</owner1_ownership_perc>
  <owner1_dob>1967-08-29</owner1_dob>
  <owner1_social_securrity_no>322727068</owner1_social_securrity_no>
  <owner1_form_of_id>Drivers License</owner1_form_of_id>
  <owner1_number>C51229067246</owner1_number>
  <owner1_expired>2025-08-29</owner1_expired>
  <owner1_issuer_state>IL</owner1_issuer_state>
  <owner1_issued_date>2021-10-21</owner1_issued_date>
</object>

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