PRE-APP COVER DETAILS
Attached Required Document Checklist :
Business Verification DocumentMerchant (Business) DBA Name :
Anthony DrainBusiness Legal Name :
Anthony DrainContact Name : Anthony Drain
Contact Phone Number : 9018282229
Physical Address :
1164 Vickery LNSTE 200City : Memphis
State : TN
Country : USA
Zip : 38016
Phone Number :
Fax Number :
Email Address : dee@impactpays.com
Website :
Billing Address
Address :
nnmCity : nmn
State : nmn
Country : nmn
Zip : 2323
Business Type
State incorporated in : Public
Type of Legal Entity : Sole Proprietor
Business Type :
Business Start Date : -
EIN/Federal Tax ID Type :
EIN/Federal Tax ID# :
Types of Goods Sold :
Ownership Information
Banking Information
Billing Type :
Name of Bank : nmnmn
ABA Routing : 000005665
Account : 5656
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 :
0%Card Keyed In :
0%= 0%
Card Present :
0%Card Not Present :
0%= 0%
MOTO :
0%Internet :
0%
Notes :
Terminal Answer
Batch Out Time : 11:00 AM
Terminal Type : 17
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 :
Front Drivers License Download
Back Drivers License Download
Voided Check Download
