MERCHANT APPLICATION

Agent ID

Sub-Agent ID

Hidden Data Variables

Intake

Who is filling out this form (Preparer)

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

Full Name *

Email *

Phone *

Please Read: 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 List:

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)

Merchant Account Information

DBA Business Name *

Formation Date *

Employees *

Time Zone *

Select option

Cannabis License Exp Date *

Hours of Operation *

Customer Service-Hours *

Customer Service-Phone *

Website *

Business Phone Number *

Business Email Address *

Cannabis License *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

Address Information

Please share address information for this account.

Physical Address *

Physical Address 2

Physical City *

Physical State *

Select option

Physical Zip *

Mailing Address

Mailing Address 2

Mailing City

Mailing State

Select option

Mailing Zip

Legal Business Information

Legal Business Name *

Federal Tax ID (EIN / TIN) *

Number of Locations *

Business Type *

Select option

Address Information

Please provide the legal address as it's shown on tax documents.

Legal Address *

Legal Address 2

City *

State *

Select option

Zip *

Documents

Please upload the required documents below.

Articles of Formation *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

Bylaws or Operating Agreement *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

IRS EIN/SS4 EIN Document *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

Management Agreement

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

Processing Information

Return Policy *

Select option

Total Monthly Sales Volume *

Est. Monthly Card Sales Volume *

Average Ticket Size *

Low Ticket Size *

Max High Ticket Size *

Current POS System (include make, model, and serial number) *

Business Category

Select option

Does the business accept tips?

Select option

Tipping format

Select option

Banking Information

Name on Account *

Account Type *

Select option

Routing Number *

Account Number *

Bank Name

Bank Address

Bank Address 2

Bank City

Bank State

Select option

Bank Zip

Bank Phone

Authorized Signer: Name *

Authorized Signer: Email Address *

Authorized Signer: Phone *

Bank Statements *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

Voided Check or Bank Letter *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

W9 *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 1 Files )

Owner Information

How many owners have 25% or more ownership?

Select option

Owner

% of Ownership *

Full Name *

Title *

Personal Email *

Personal Phone *

Date of Birth *

Social Security Number *

Driver's License Number *

DL Expiration Date *

DL State Issued *

Residential Address (no PO box) *

Driver's License or Passport *

JPEG, JPG, PNG or PDF ( max 1 Files )

Second Owner

If more than 25% ownership

% of Ownership

Full Name

Title

Personal Email

Personal Phone

Date of Birth

Social Security Number

Driver's License Number

DL Expiration Date

DL State Issued

Residential Address (no PO box)

Driver's License or Passport

PDF, JPEG, JPG or PNG ( max 1 Files )

Third Owner

If more than 25% ownership

% of Ownership

Full Name

Title

Personal Email

Personal Phone

Date of Birth

Social Security Number

Driver's License Number

DL Expiration Date

DL State Issued

Residential Address (no PO box)

Driver's License or Passport

PDF, JPEG, JPG or PNG ( max 1 Files )

Fourth Owner

If more than 25% ownership

% of Ownership

Full Name

Title

Personal Email

Personal Phone

Date of Birth

Social Security Number

Driver's License Number

DL Expiration Date

DL State Issued

Residential Address (no PO box)

Driver's License or Passport

JPEG, JPG, PDF or PNG ( max 1 Files )

Equipment Information
To be filled out by Agent Only

New Equipment Required *

Select option

Total amount of ID scanners needed?

Total amount of terminals needed?

Total amount of counter-top terminals needed?

$240 each

Total amount of mobile Wifi Only QD2 units needed?

$415 Each

Total amount of countertop units w/power cord Wifi QD4 needed?

$275 Each

How many should be sim card activated?

Mobile 4G cellular: $35/month

How many should be 4G/LTE cellular activated?

Please provide the email addresses for Online Portal Access:

Separate each email address with a comma ","

888-809-2512

3000 Custer Road, Ste 270-7014

Plano, TX 75075

Privacy Policy

MERCHANT APPLICATION

Intake

Document List:

Merchant Account Information

Legal Business Information

Processing Information

Banking Information

Owner Information

Equipment InformationTo be filled out by Agent Only

Equipment Information
To be filled out by Agent Only