Company
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(enter "SAME" if the DBA matches
the Business/Corporate Name)
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Business Address
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| Statement Mailing Address
(same?)
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Legal Organization:
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| Federal Tax ID Number: |
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(9 digits only ex. 115553333, if a sole proprietorship the SS# of
owner will suffice)
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Phone:
(10 digits only ex. 5551236789) |
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(For Internet stores, this phone number must match the phone number listed on
the "Contact Info" of your website.)
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| Email: |
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| Website: |
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| Months in present business?: |
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(ex. enter 36 for 3 years)
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Do you currently process
credit cards?: |
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Merchandise/Service
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Description of Merchandise
or Services Rendered
(1000 characters max)
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Average Visa/MasterCard
Sale Amount: $ |
.00
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(whole dollar amounts up to 5 digits only)
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Highest Visa/MasterCard
Sale Amount: $ |
.00
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(whole dollar amounts up to 5 digits only)
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Total Visa/MasterCard
Monthly Sales Volume: $ |
.00
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(whole dollar amounts up to 10 digits only)
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Company
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Primary Business
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Primary Sales Method |
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