Merchant Application

BUSINESS DETAILS

Legal Name

Address

Phone

Website

DBA

Fed Tax Id (##-#######)

Business Start Date

City, State, Zip

Company Type

Business Location

Products/Services Sold

Please City, State

Owner# 1/Principal Information

Name

Address

City, State Zip

Home Phone

Mobile

% of Ownership

Date of Birth

SSN#

Owner# 2/Principal Information

Name

Address

City, State Zip

Home Phone

Mobile

% of Ownership

Date of Birth

SSN#

Signature

Clear Signature

Files

Please upload your last 3 months business bank statements

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Please add your last 3 months credit card processing statements (Optional)

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Credit Authorization

I authorize

I authorize

By signing below, the Merchant and its Owners / Principals:

(1) certify that all information and documents submitted in connection with this application is true, correct and complete;

(2) authorize The Belmont Franklin Group its agents, partners, and lenders, to receive credit reports and any other information regarding the Merchant and its Owners and Principals from third parties, to verify any information provided on the application;

(3) to receive an occasional promotion or offer by email or fax.

(4) By signing up via this form, I agree to get text and email messages from The Belmont Franklin Group relating to my application and may receive solicitations from time to time. Message frequency varies. Message & data rates may apply. Reply STOP to opt-out at any time or HELP for more information.

Merchant Application

BUSINESS DETAILS

Legal Name

Address

Phone

Website

DBA

Fed Tax Id (##-#######)

Business Start Date

City, State, Zip

Company Type

Merchant Type

Business Location

Products/Services Sold

ADDRESS

City

State/Province

Postal Code

Country

Owner# 1/Principal Information

Name

Address

City, State Zip

Home Phone

Mobile

% of Ownership

Date of Birth

SSN#

Owner# 2/Principal Information

Name

Address

City, State Zip

Home Phone

Mobile

% of Ownership

Date of Birth

SSN#

Signature

Files

Please upload your last 3 months business bank statements

Please add your last 3 months credit card processing statements (Optional)

Credit Authorization

I authorize

By signing below, the Merchant and its Owners / Principals:

(1) certify that all information and documents submitted in connection with this application is true, correct and complete;

(2) authorize The Belmont Franklin Group its agents, partners, and lenders, to receive credit reports and any other information regarding the Merchant and its Owners and Principals from third parties, to verify any information provided on the application;

(3) to receive an occasional promotion or offer by email or fax.

Merchant Application

BUSINESS DETAILS

Owner# 1/Principal Information

Owner# 2/Principal Information

Files

Credit Authorization

Merchant Application

BUSINESS DETAILS

ADDRESS

Owner# 1/Principal Information

Owner# 2/Principal Information

Files

Credit Authorization

Explore

Help