Application - flexpaymentsystems.com

Business Type(Required)

Name of Ownership Entity (Legal Name)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone #(Landline)(Required)

Federal Tax ID(Required)

Business Email(Required)

Mobile Phone Number(Required)

Product or Service Sold(explain in full)(Required)

How Long Have You Been In Business (Years and Months)(Required)

Previous Processor? If Yes, Who?(Required)

Same as Legal Info

DBA Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Title(Required)

Name(Required)

First Last

Email(Required)

Percent Ownership(Required)

DOB(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SSN(Required)

Transit Routing #(Required)

Bank Account Number(Required)

Next Day Funding

Yes

Days ACH Hold

0

1

File

Max. file size: 128 MB.

Signature(Required)