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ContractFree Equipment Agreement • January 20th, 2023 • Texas
Merchant Application & Agreement42 Main StreetRev 19 LLC (dba Agile Financial Systems) Hudson, MA 017492535 E. Southlake Blvd, #140 978-562-2222Southlake, TX 76092817-754-1675 | www.go-afs.com Agent Name: Agent #: Merchant #: MCC: Merchant Name (DBA Or Trade Name) Corporate/Legal IRS Filing Name Location Address Corporate Address (If Different) City State Zip City State Zip Contact Name Contact Email Address Business Telephone Federal Tax ID # Does this location currently accept payment cards? Yes No Has merchant or owners/ principals ever been terminated from accepting payment cards from any payment network for this business or any other business? Yes No (If yes, please explain reason for termination) TYPE OF BUSINESS: NATURE OF BUSINESS: Individual/Sole Proprietor Corporation Government Private State: Partnership LLC Non-Profit (Provide evidence of 501(c)(3) Status)Public Traded-Stock Symbol Years in Business Months in Business Product or Service being offered Retail Mail/Phone Order
