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Encrypted digital application
Which plan are you applying for?
*
Payments
Point of Sale
E-commerce
Select any add-ons needed
Invoicing
Mobile processing
Smart terminal
Gift cards
Food safety
Online store & app
1. Business information
Legal name of business
*
🛈
Legal Address
*
Suite
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
ZIP
*
DBA Name
*
🛈
DBA Address
*
Suite
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
ZIP
*
Email address for notices
*
Customer service number (No dashes. Format: XXXXXXXXXX)
*
🛈
Date Business Started (MM/DD/YYYY)
*
+
Type of business
*
Retail
Retail with tips
Restaurant
Internet
MOTO (mail order/telephone order)
Lodging
Supermarket
Utility
Pharmacy
Website address
Percentage Internet sales
*
Percentage MOTO (mail order/ telephone order) sales
*
Percentage Business to Business sales
*
Prior Bankruptcies?
*
Yes
No
If yes , filing date
+
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