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Partner Bank Application Information Requirements

We will use the information you provide in this form to fill out a bank application on your behalf. Our bank will then forward the electronic version of the application to you for review and electronic signature.

Street/City/Zip

Yes
No

If applicable

If applicable

PLEASE SEND THESE FORMS AS AN ATTACHMENT IN AN EMAIL TO SUPPORT@PAYQUIQ.COM

- Last months credit card statement
- Current Financial Statement
- The bank may require a copy of the signer's ID. You may send it or wait until they request it.

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

  

Total:   

For added Security please check the box below.