MERCHANT PROCESSING APPLICATION AND AGREEMENTMerchant Processing Application and Agreement • September 6th, 2018
OWNER/PARTNER/OFFICER 3 OWNER/PARTNER/OFFICER 4 Name Name Title % Of Ownership* Title % Of Ownership* Guarantor** Yes _ No Guarantor** Yes No Home Addresss Home Address City State Zip City State Zip Telephone Telephone Social Security # Date of Birth Social Security # Date of Birth Email Address Email Address Prior Bankruptcie Yes No _Business and/or Personal Prior Bankruptcies Yes No Business and/or Personal Date Discharged Date Discharged
MERCHANT PROCESSING APPLICATION AND AGREEMENTMerchant Processing Application and Agreement • July 30th, 2009
