Step 1 Step 2Step 3Step 4Step 5Step 6Step 7Final Step I. BUSINESS INFORMATION * Legal Business Name DBA (if applicable) * Tax ID/EIN * Entity Type Sole ProprietorshipLLCCorporationPartnershipNonprofit Next CORPORATE ADDRESS AND INFORMATION * Address * City, State, Zip * Phone Fax (optional) * Email Website (optional) MCC SIC Code (optional) Indicate if Classified as Small BusinessDisadvantaged Business PreviousNext PHYSICAL ADDRESS AND INFORMATION * Address: (No P.O. Box!) * City, State, Zip * Phone Fax (optional) * Customer Service Phone * Do you currently accept Visa/MC/Discover® Network? YesNo Date Business Started (Mo/Yr) Number of Locations PreviousNext II. PROCESSING VOLUME (ALL CARD TYPES) * Average Ticket ($) * Typical High‐End Ticket ($) * Monthly Visa/Mastercard/Discover Volume ($) *Monthly American Express Volume ($) Percent of Business (MUST = 100%) * Card Swiped / EMV (%) * Keyed (Card Present) (%) * Keyed (Card Not Present) (%) Sales Method (MUST = 100%) * Store Front (Cardholder Present) (%) * Internet Services (eCommerce) (%) * Mail / Phone Order (%) Other (optional) (%) Specify (if other) PreviousNext III. PRODUCT ADVERTISING, SALES, AND DELIVERY ‐ ‐ REQUIRED QUESTIONS 1‐9 MUST BE ANSWERED ‐ MOTO QUESTIONS – 1‐17 MUST BE ANSWERED 1. *Description of product sold 2. Name of fulfillment house, if any 3. *How does the customer purchase/order the product? In PersonBy MailBy PhoneBy FaxInternet 4. *At what point is consumer paid in full? 100% Paid in Advance100% Paid Upon Delivery/Completion 5. *What is the delivery time frame to the consumer? 0‐7 days8‐14 days15‐30 days30+ days 6. When you receive an authorization, how long before the merchandise is shipped? 7. What is your return, cancellation, or refund policy? 8. List the name(s) and address(es) of vendor(s) from whom the product is purchased 9. *What percentage of your business is deposits % *What percentage of your business is future services % *What percentage of your business is cash & carry % 10. What shipping service do you use to deliver products to consumers? Fed ExUPSAirborneUSPS Express 11. In what geographic areas will the product be marketed and sold? 12. How do you advertise? CatalogTV or RadioDirect Mail/FlyersInternet 13. What percentage of sales transactions are with international cards? 14. What is your warranty/guarantee? By MerchantBy Manufacturer 15. Who owns product? MerchantVendor (Drop Ship Required) 16. Is your business seasonal? YesNo Months: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember to JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 17. Are consumers required to provide a deposit? NoYes (Percentage: %) Incremental Payments (Percentages % ) PreviousNext IV. Banking Information for Credits (for example: Deposits) * Bank Account #1 (DDA) :(attach copy of voided check) * Bank Routing #1 (ABA) * Bank Name * Account Type CheckingSavingsGeneral Ledger Discount Method DailyMonthly Deposit Time Frame Standard (1 Day Hold)Alternate Funding (Subject to approval) Banking Information for Debits (for example: Fees) Same Address as AboveDifferent Address * Bank Account #2 (DDA) :(attach copy of voided check) * Bank Routing #2 (ABA) * Bank Name * Account Type CheckingSavingsGeneral Ledger PreviousNext V. OWNERS/OFFICERS (MUST REFLECT OWNERSHIP OF 25% OR MORE) * Ownership: Each individual who directly or indirectly owns 25% or more of equity interest of the within named legal entity MUST enter their Information . Owner 1 * Name * Title * Ownership % * Social Security # * Date of birth * Cell Phone Number * Email Address * Driver’s License # / State * Residence Address, City, State, Zip * Do you have more owners ? NoWe have 1 more ownerWe have 2 more ownersWe have 3 more owners Owner 2 Name Title Ownership % Social Security # Date of birth Cell Phone Number Email Address Driver’s License # / State Residence Address, City, State, Zip Owner 3 Name Title Ownership % Social Security # Date of birth Cell Phone Number Email Address Driver’s License # / State Residence Address, City, State, Zip Owner 4 Name Title Ownership % Social Security # Date of birth Cell Phone Number Email Address Driver’s License # / State Residence Address, City, State, Zip PreviousNext Controller: Any individual with significant management responsibility (example: CEO, CFO, Treasurer, President, VP, etc.) Controller Name Title Ownership % Social Security # Date of birth Cell Phone Number Email Address Driver’s License # / State Residence Address, City, State, Zip * Declaration I hereby certify, to the best of my knowledge, that the information provided above is complete and correct. Print Name: Title: Signature: Date: Δ
