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Solutions of Interest (Select all that apply)

Debit Card ProcessingCredit Card ProcessingOnline Payment SolutionATM ServicesCannabis Friendly Bank Accounts

Sector of CannabisCBDTHCHEMPAncillary business

Type of BusinessDeliveryStore Front

Business InformationMerchant Corporate Name *Merchant Business Name (Doing Business As) *Merchant Address *Merchant City *Merchant State *Merchant Zip*

Business Phone*

Business Email Address*

Product/Services Sold*

State Incorporated*

Month & Year Started*

Federal Tax ID #*

Business License #*

Business Start Date*

State Filed*

Number of Employees*

Business Entity Type*

Monthly Sales Volume*

Average Ticket Size*

Highest Ticket Amount*

Shipping Address*

Ownership InformationNumber of Owners*

Owner 1 InformationFull Name*

Driver Lic# & State*

Date of Birth*

SSN*

Ownership Percentage*

Title / Position*

Address*

City*

State*

Zip Code*

Home/Cell Phone*

Owner 2 InformationFull Name

Driver Lic# & State

Date of Birth

SSN

Ownership Percentage

Title / Position

Address

City

State

Zip Code

Home/Cell Phone

Business Bank InformationFinancial Institution Name*Company/Depositor name as shown on the bank records*Bank Routing #*Bank Account#*

Type of AccountCheckingSavings

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