Bank Card Merchant Agreement ApplicationBank Card Merchant Agreement Application • May 3rd, 2022
MERCHANT INFORMATION To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial ins titutions to obtain, verify, and record information that identifies each individual or business that opens an account. What this means to you— When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We will also ask to see your driver’s license and/or other identifying documents. Federal Tax ID Number of Locations Has this Business Ever Filed Bankruptcy?Yes Date: ANY PRESENT INTENT TO FILE BANKRUPTCY?Yes No BUSINESS LEGAL NAME (IF ORGANIZED AS A SOLE PROPRIETORSHIP, MUST BE OWNER’S PERSONAL NAME) – TO AVOID IRSPENALTIES, LEGAL NAME MUST MATCH FEDERAL INCOME TAX RETURN Doing Business As (“DBA”)/Disregarded Entity/Store Name (Store Name is name that will appear on receipt) Store Number MCC/SIC Physical Address (Physical address only—No PO Boxes) Years at Address Cit
