Application Information for E-Signature

The below fields will be used to generate an electronic application for signature.

Business Legal Name:

DBA Name:

Business Address:

City:

State:

Zip:

Business Phone:

Business Fax:

Email:

Requested Service Start Date:

Not Set

Is this date flexible?

YesNo

Products/Services Sold:

Fed Tax ID:

Fed ID Month / Year Started:

Tax Filing Type?

(Sole Proprietor, Partnership, Corporation – Public or Private)

Tax Exempt Organization?

YesNo

Number of Employees?

Total Gross Annual Sales:

Estimated Annual Credit Card Sales:

Estimated Average $$ Credit Card Individual Sale Amount:

Estimated Highest $$ Credit Card Individual Sale Amount:

Signor (Must be officer or controller of private Corp., member LLC, or individual only of sole proprietorship):

Signor/Owner Name:

Signor Title:

Signor Percentage ownership in company:

Signor Date of Birth:

Not Set

Signor Home Phone:

Signor Home Address:

City:

State:

Zip:

Deposit Bank Name (checking only):

Bank Name:

Bank Account #:

Bank Routing #:

Bank Phone:

Please complete and return via email to your Sales Consultant.
An electronic application will be generated and emailed to you for e-signature.
We will need a copy of a voided business check to complete setup of your merchant processing account.

Information

AZCPOS is the optimal solution for managing various businesses, including Fine Dining, Quick Service, Coffee & Tea Shops, Pizza Shops, Grocery Stores, Beauty Salons, Bar & Lounge, and Retail Stores. Feel free to reach out to our AZCPOS hotline for expert advice. We're here to assist and address all your inquiries.

17451 Nichols Ln STE A
Huntington Beach, CA 92647

(714) 716-1718

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