Application: Please fill out as completely as possible. Applying For: ACH Credit Card Both Name: Email: Phone: FAX Number: Corporate Business Name Street: City: State: AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY ZIP Code: Business Location Type (retail/office/home/Internet) EIN: Number of Years in Business: Have any owners filed bankruptcy? Personal Business Both General Description of Your Products or Services: Estimated ACH Dollar Volume (monthly) Estimated Credit Card Dollar Volume (monthly) Have any owners filed bankruptcy
