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Business Information
Business Name
Opersating Address
Address 2
City
State/Zone
- Odaberi županiju -
Postal Code
Contact E-mail
Website Address
Country of Origin
- Odaberi zemlju -
Albania
Algeria
Austria
Bahrain
Belgium
Bosnia and Herzegovina
Bulgaria
Canada
China
Croatia
Cyprus
Czech Republic
Denmark
Egypt
Estonia
Faroe Islands
Finland
France
France, Metropolitan
Georgia
Germany
Gibraltar
Greece
Guernsey
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Islamic Republic of Iran
Isle of Man
Israel
Italy
Japan
Jersey
Jordan
Kazakhstan
Korea
Kuwait
Laos
Latvia
Lebanon
Liberia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malaysia
Malta
Mexico
Moldova, Republic of
Monaco
Mongolia
Montenegro
Morocco
Netherlands
Norway
Oman
Pakistan
Palestine Authority
Philippines
Poland
Portugal
Qatar
Republic of Serbia
Romania
San Marino
Saudi Arabia
Serbia
Singapore
Slovakia
Slovenia
Spain
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Thailand
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom (Great Britain)
United States
Yemen
Country of Primary Operations
- Odaberi zemlju -
Albania
Algeria
Austria
Bahrain
Belgium
Bosnia and Herzegovina
Bulgaria
Canada
China
Croatia
Cyprus
Czech Republic
Denmark
Egypt
Estonia
Faroe Islands
Finland
France
France, Metropolitan
Georgia
Germany
Gibraltar
Greece
Guernsey
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Islamic Republic of Iran
Isle of Man
Israel
Italy
Japan
Jersey
Jordan
Kazakhstan
Korea
Kuwait
Laos
Latvia
Lebanon
Liberia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malaysia
Malta
Mexico
Moldova, Republic of
Monaco
Mongolia
Montenegro
Morocco
Netherlands
Norway
Oman
Pakistan
Palestine Authority
Philippines
Poland
Portugal
Qatar
Republic of Serbia
Romania
San Marino
Saudi Arabia
Serbia
Singapore
Slovakia
Slovenia
Spain
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Thailand
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom (Great Britain)
United States
Yemen
Reqired Documentation Checklist
Billing Address
Upload drugu datoteku
Prijenos datoteke
Voided Check (please upload)
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Prijenos datoteke
IRS Form SS-4
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Prijenos datoteke
Busniess Licence
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Prijenos datoteke
Checking Account
Upload drugu datoteku
Prijenos datoteke
Owner's Drivers License
Upload drugu datoteku
Prijenos datoteke
Specialty Licences
Upload drugu datoteku
Prijenos datoteke
Certificate of Good Standing (for faster approval)
Upload drugu datoteku
Prijenos datoteke
Business Billing Information
Same as the Business Address
Business Billing Address
Address 2
City
State/Zone
- Odaberi županiju -
Aberdeen
Aberdeenshire
Anglesey
Angus
Antrim and Newtownabbey
Ards and North Down
Argyll and Bute
Armagh City, Banbridge and Craigavon
Avon
Banffshire
Bedfordshire
Belfast City
Berkshire
Berwickshire
Blaenau Gwent
Bridgend
Bristol
Buckinghamshire
Caerphilly
Caithness
Cambridgeshire
Cardiff
Carmarthenshire
Causeway Coast and Glens
Ceredigion
Cheshire
Clackmannanshire
Cleveland
Clwyd
Conwy
Cornwall
County Antrim
County Armagh
County Down
County Fermanagh
County Londonderry
County Tyrone
Cumbria
Denbighshire
Derbyshire
Derry and Strabane
Devon
Dorset
Dumfries and Galloway
Dumfries-shire
Dundee
Durham
Dyfed
East Ayrshire
East Dunbartonshire
East Lothian
East Renfrewshire
East Riding of Yorkshire
East Sussex
Edinburgh
Essex
Falkirk
Fermanagh and Omagh
Fife
Flintshire
Glasgow
Gloucestershire
Greater London
Greater Manchester
Gwynedd
Hampshire
Herefordshire
Hertfordshire
Highlands
Humberside
Inverclyde
Inverness-shire
Isle of Wight
Isles of Scilly
Kent
Kincardineshire
Lancashire
Leicestershire
Lincolnshire
Lisburn and Castlereagh
Merionethshire
Merseyside
Merthyr Tydfil
Mid and East Antrim
Mid-Ulster
Middlesex
Midlothian
Monmouthshire
Moray
Nairnshire
Neath Port Talbot
Newport
Newry, Mourne and Down
Norfolk
North Ayrshire
North Lanarkshire
North Yorkshire
Northamptonshire
Northumberland
Nottinghamshire
Orkney Islands
Oxfordshire
Peebles-shire
Pembrokeshire
Perth and Kinross
Powys
Renfrewshire
Rhondda Cynon Taff
Roxburghshire
Rutland
Scottish Borders
Selkirkshire
Shetland Islands
Shropshire
Somerset
South Ayrshire
South Lanarkshire
South Yorkshire
Staffordshire
Stirling
Stirlingshire
Suffolk
Surrey
Sutherland
Swansea
Torfaen
Tyne and Wear
Vale of Glamorgan
Warwickshire
West Dunbartonshire
West Lothian
West Midlands
West Sussex
West Yorkshire
Western Isles
Wigtownshire
Wiltshire
Worcestershire
Wrexham
Yorkshire
Postal Code
Country
- Odaberi zemlju -
Albania
Algeria
Austria
Bahrain
Belgium
Bosnia and Herzegovina
Bulgaria
Canada
China
Croatia
Cyprus
Czech Republic
Denmark
Egypt
Estonia
Faroe Islands
Finland
France
France, Metropolitan
Georgia
Germany
Gibraltar
Greece
Guernsey
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Islamic Republic of Iran
Isle of Man
Israel
Italy
Japan
Jersey
Jordan
Kazakhstan
Korea
Kuwait
Laos
Latvia
Lebanon
Liberia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malaysia
Malta
Mexico
Moldova, Republic of
Monaco
Mongolia
Montenegro
Morocco
Netherlands
Norway
Oman
Pakistan
Palestine Authority
Philippines
Poland
Portugal
Qatar
Republic of Serbia
Romania
San Marino
Saudi Arabia
Serbia
Singapore
Slovakia
Slovenia
Spain
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Thailand
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom (Great Britain)
United States
Yemen
Business Legal Designation
LLC Type 2
-- choose option --
Partnership
Corporation
Disregarded Entity
C Corp Type
-- choose option --
Closely Held
Private
Public
..
-- choose option --
General Partnership
Limited Partnership
Sole Proprietorship
Sub S Corporate
Estate
Trust
Tax Examption Organization
Unincorporated Association
Government
Other
Other explanation
Specialty License(s) ID
EIN
Year Established
Length of Ownership (yrs & mos)
EBT Services
EBT PIN Debit
EBT Number
Price per Month
Price per Authorization
Additional Services
XBanc Trust Account
Inital Transfer ($)
Mo. Transfer ($)
Cash Incentive
Percent
Wealth Builder
Percent
Interchange Plus
Percent
Per Authorization
Owner Information
Full Name of Primary Owner
Date of Birth
SSN
Telephone
Current Street Address
Ownership Percentage
Yrs. on Address
Email
City
State
- Odaberi županiju -
Aberdeen
Aberdeenshire
Anglesey
Angus
Antrim and Newtownabbey
Ards and North Down
Argyll and Bute
Armagh City, Banbridge and Craigavon
Avon
Banffshire
Bedfordshire
Belfast City
Berkshire
Berwickshire
Blaenau Gwent
Bridgend
Bristol
Buckinghamshire
Caerphilly
Caithness
Cambridgeshire
Cardiff
Carmarthenshire
Causeway Coast and Glens
Ceredigion
Cheshire
Clackmannanshire
Cleveland
Clwyd
Conwy
Cornwall
County Antrim
County Armagh
County Down
County Fermanagh
County Londonderry
County Tyrone
Cumbria
Denbighshire
Derbyshire
Derry and Strabane
Devon
Dorset
Dumfries and Galloway
Dumfries-shire
Dundee
Durham
Dyfed
East Ayrshire
East Dunbartonshire
East Lothian
East Renfrewshire
East Riding of Yorkshire
East Sussex
Edinburgh
Essex
Falkirk
Fermanagh and Omagh
Fife
Flintshire
Glasgow
Gloucestershire
Greater London
Greater Manchester
Gwynedd
Hampshire
Herefordshire
Hertfordshire
Highlands
Humberside
Inverclyde
Inverness-shire
Isle of Wight
Isles of Scilly
Kent
Kincardineshire
Lancashire
Leicestershire
Lincolnshire
Lisburn and Castlereagh
Merionethshire
Merseyside
Merthyr Tydfil
Mid and East Antrim
Mid-Ulster
Middlesex
Midlothian
Monmouthshire
Moray
Nairnshire
Neath Port Talbot
Newport
Newry, Mourne and Down
Norfolk
North Ayrshire
North Lanarkshire
North Yorkshire
Northamptonshire
Northumberland
Nottinghamshire
Orkney Islands
Oxfordshire
Peebles-shire
Pembrokeshire
Perth and Kinross
Powys
Renfrewshire
Rhondda Cynon Taff
Roxburghshire
Rutland
Scottish Borders
Selkirkshire
Shetland Islands
Shropshire
Somerset
South Ayrshire
South Lanarkshire
South Yorkshire
Staffordshire
Stirling
Stirlingshire
Suffolk
Surrey
Sutherland
Swansea
Torfaen
Tyne and Wear
Vale of Glamorgan
Warwickshire
West Dunbartonshire
West Lothian
West Midlands
West Sussex
West Yorkshire
Western Isles
Wigtownshire
Wiltshire
Worcestershire
Wrexham
Yorkshire
ZIP Code
Previous Street Address (if current is under 2 years)
Yrs. on Address
City
State
- Odaberi županiju -
Aberdeen
Aberdeenshire
Anglesey
Angus
Antrim and Newtownabbey
Ards and North Down
Argyll and Bute
Armagh City, Banbridge and Craigavon
Avon
Banffshire
Bedfordshire
Belfast City
Berkshire
Berwickshire
Blaenau Gwent
Bridgend
Bristol
Buckinghamshire
Caerphilly
Caithness
Cambridgeshire
Cardiff
Carmarthenshire
Causeway Coast and Glens
Ceredigion
Cheshire
Clackmannanshire
Cleveland
Clwyd
Conwy
Cornwall
County Antrim
County Armagh
County Down
County Fermanagh
County Londonderry
County Tyrone
Cumbria
Denbighshire
Derbyshire
Derry and Strabane
Devon
Dorset
Dumfries and Galloway
Dumfries-shire
Dundee
Durham
Dyfed
East Ayrshire
East Dunbartonshire
East Lothian
East Renfrewshire
East Riding of Yorkshire
East Sussex
Edinburgh
Essex
Falkirk
Fermanagh and Omagh
Fife
Flintshire
Glasgow
Gloucestershire
Greater London
Greater Manchester
Gwynedd
Hampshire
Herefordshire
Hertfordshire
Highlands
Humberside
Inverclyde
Inverness-shire
Isle of Wight
Isles of Scilly
Kent
Kincardineshire
Lancashire
Leicestershire
Lincolnshire
Lisburn and Castlereagh
Merionethshire
Merseyside
Merthyr Tydfil
Mid and East Antrim
Mid-Ulster
Middlesex
Midlothian
Monmouthshire
Moray
Nairnshire
Neath Port Talbot
Newport
Newry, Mourne and Down
Norfolk
North Ayrshire
North Lanarkshire
North Yorkshire
Northamptonshire
Northumberland
Nottinghamshire
Orkney Islands
Oxfordshire
Peebles-shire
Pembrokeshire
Perth and Kinross
Powys
Renfrewshire
Rhondda Cynon Taff
Roxburghshire
Rutland
Scottish Borders
Selkirkshire
Shetland Islands
Shropshire
Somerset
South Ayrshire
South Lanarkshire
South Yorkshire
Staffordshire
Stirling
Stirlingshire
Suffolk
Surrey
Sutherland
Swansea
Torfaen
Tyne and Wear
Vale of Glamorgan
Warwickshire
West Dunbartonshire
West Lothian
West Midlands
West Sussex
West Yorkshire
Western Isles
Wigtownshire
Wiltshire
Worcestershire
Wrexham
Yorkshire
ZIP Code
Processing information
Previous processor
Refund Policy (none, 30days, exchange only, etc.)
Terminal(s) Brand & Model
Terminal(s)
--- select option ---
Own
Purchase
Rent
Quantity
Cost Each
Statement Delivery Preference
--- select option ---
Email
Company Address
Charge Back Delivery Preference
--- select option ---
Email
Company Address
Processing Information
Annual Volume ($)
Average Ticket ($)
Highest Ticket ($)
Projected Monthly Sales
Projected Yearly Sales
Highest Ticket Frequency
According to the Merchant Agreement for Transaction Services, it is necessary for Merchant to provide its banking information to facilitate billing and payments. The Merchant must inform the Processor of any changes to its banking details and accounts. The Processor will not be liable for any funds incorrectly transferred due to a change in banking information or errors that directly resulted from the information provided by Merchant. Merchant authorizes the Processor to debit from the Merchant’s bank account all monthly payments and other amounts owed to the Processor related to the Transaction Services. This authorization shall remain in effect after termination of the authorization shall remain in effect after termination of the Agreement and for as long as Merchant owes any amounts to the Processor. Merchant agrees that the Processor will not be liable for any loss or damage incurred as a result of anything done or not done according to this authorization. If the account is transferred to another branch or the account is closed, and an account is opened at another bank, this authorization shall have the same force and effect as if it originally was directed to that branch or bank. The undersigned Guarantors acknowledge and agree to be bound by all the terms and conditions of this Agreement and unconditionally guarantee the performance of this Agreement. By signing below, Merchant (I) represents that the information provided by Merchant in this Agreement is accurate, complete, and not misleading; (II) acknowledges that Merchant has read and understands this Agreement and Operating Procedures and agrees to be bound by their terms; and (III) authorizes the Processor and its agents to credit and debit the Designated Automatic Funds Transfer Account in accordance with this Agreement.
- Odaberi -
I attest to the satement above and that I have read and agree to the Service Agreement
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