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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.

Business Information

* Legal Name of business as submitted on the last income tax return

* Length In Business

* Business Street Address

* Business City, State, Zip

* Website

* Primary Phone Number

* Primary Contact Name/Title

* Primary Contact Email

* Federal Tax ID

Patriot Act Information

* Application Signer Name

* Application Signer Title

* Application Signer Home Address

Street/City/Zip

* Application Signer Email Address

* Application Signer Home Phone

* Driver's License Number

* Date of Issuance

* State of Issuance

* Expiration Date

Processing and Banking Information

Have you accepted credit cards before?

	Yes
	No

If yes, what is the name of the processor?

Maximum anticipated volume for both credit card and ACH

* Bank Routing Number

* Checking Account Number

* Bank Name

Trade References

* Trade Reference 1 Name

Trade Reference 1 Account Number

If applicable

* Trade Reference 1 Phone

* Trade Reference 2 Name

Trade Reference 2 Account Number

If applicable

* Trade Reference 2 Phone

Document Attachments

PLEASE SEND THESE FORMS AS AN ATTACHMENT IN AN EMAIL TO [email protected]

- 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.