Domestic Pre‑Application Worksheet
Business Information
Legal Name of Business
DBA
EIN/Tax Company ID
Business Start Date
State Filed
Business Type
Sole Proprietor
Corporation
LLC
Non‑Profit
Government
Other
Street Address
Mailing Address
Business Phone
Business Email
Customer Service Phone
Customer Service Email
Website URL
Authorized Contact Name
Principal Information
Full Name
Ownership %
Title
Home Phone
Date of Birth
SSN
Driver License #
Exp Date
State
Home Address
Personal Email
Settlement Account Information
Bank Name
Contact Name
Routing Number
Account Number
Products / Services Sold
Processing Volume
Total Monthly Volume
Visa/MC Volume
Amex Volume
Average Ticket
Highest Ticket
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