Application Information for E-Signature
The below fields will be used to generate an electronic application for signature.
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 Social Security #:
Signor Date of Birth:
Not Set
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 most optimal solution for you to management and operation your Cuisine - Restaurant - Tea Shop - Cafe Shop - Juice Shop - Food to go. Do not hesitate to call our AZCPOS hotline for advice. We are always ready to assist and answer all your questions.
17451 Nichols Ln STE A
Huntington Beach, CA 92647
(714) 716-1718
Forms
Clover merchant request form
POS merchant request form
POS application form
Application Information for E-Signature
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