MERCHANT APPLICATION

Intake Information

Form Data Variables

Source: Referring Agency

Who is completing this application? *

Select one

Agent
Merchant
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Referring Agent Name

Type "none" if no agent

Referring Agent Email Address

Type "none" if no agent

Preferred Business Contact Person

Please share the contact information of the primary point of contact for the business.

Full Name *

Email Address *

Phone Number *

Document Upload Required
Before proceeding to the next step, please ensure you have the documents listed ready to go. Check each box to indicate that each file is ready to be uploaded. You will not be able to complete this multi-step merchant application unless the files are uploaded.

Document Checklist *

3 months current business banking statements ( INCLUDE ALL PAGES)

Voided Check or Bank Letter

Articles of Formation/Incorporation/Organization

Bylaws or Operating Agreement (Must Include the Percentage of Ownership for each Owner)

IRS EIN/SS4 EIN Document

Cannabis License

Signed W-9

DL or Passport for EACH OWNER

Management Agreement (if merchant business is operated by a Management Company)

888-809-2512

3000 Custer Road, Ste 270-7014

Plano, TX 75075

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