• Step 1
    • Step 2
    • Step 3
    • Step 4
    • Step 5
    • Step 6
    • Step 7
    • Final Step

    I. BUSINESS INFORMATION



    CORPORATE ADDRESS AND INFORMATION
     


    PHYSICAL ADDRESS AND INFORMATION

    YesNo




    II. PROCESSING VOLUME (ALL CARD TYPES)

    Percent of Business (MUST = 100%)

    Sales Method (MUST = 100%)
     


    III. PRODUCT ADVERTISING, SALES, AND DELIVERY ‐ ‐ REQUIRED QUESTIONS 1‐9 MUST BE ANSWERED ‐ MOTO QUESTIONS – 1‐17 MUST BE ANSWERED



    *What percentage of your business is future services %  


    *What percentage of your business is cash & carry %



    Fed ExUPSAirborneUSPS Express


    CatalogTV or RadioDirect Mail/FlyersInternet


    By MerchantBy Manufacturer




    MerchantVendor (Drop Ship Required)


    YesNo
    Months:

    to



    NoYes

    (Percentage: %)


    Incremental Payments

    (Percentages % )










    IV. Banking Information for Credits (for example: Deposits)

    CheckingSavingsGeneral Ledger


    DailyMonthly


    Standard (1 Day Hold)Alternate Funding (Subject to approval)


    Banking Information for Debits (for example: Fees)


    CheckingSavingsGeneral Ledger

     



    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


    Owner 2




    Owner 3




    Owner 4




    Controller: Any individual with significant management responsibility (example: CEO, CFO, Treasurer, President, VP, etc.)
    Controller
    * Declaration
    I hereby certify, to the best of my knowledge, that the information provided above is complete and correct.

    Print Name:


    Title:


    Signature:

    Date: